Individualized Treatment Patterns for Patients with Narcolepsy Treated with Oxybate: A Clinical Practice Perspective

Figures & data

Table 1 Physician Recommendations for Oxybate Dosing Adjustments for Representative Patient Vignettes

Patient Vignette	Recommendations for SXB Adjustments^a	Frequency of Response, n (%)
Vignette 1:
Sarah is a 45-year-old female professional with narcolepsy who is prescribed SXB and was titrated to an efficacious and tolerable dose of 6 g per night. Her typical dosing regimen is 3 g at bedtime and 3 g 3–4 hours later; she awakens spontaneously to take her second nightly dose without an alarm. She was recently promoted at work and now has to get up early on occasion to attend a morning meeting or to catch an early flight.	Change strength of dose(s)	14 (56)
	Change timing of dose(s)	14 (56)
	Change number of dose(s)	6 (24)
Vignette 2:
Now, assume Sarah would like to attend a late-evening work event that would keep her up 2 hours later than usual, but also has an early meeting the next day where she needs to be up 1 hour earlier than usual.	Change number of dose(s)	15 (60)
	Change strength of dose(s)	10 (40)
	Change timing of dose(s)	7 (28)
	Discontinue SXB	1 (4)
Vignette 3:
Monica is a 30-year-old female diagnosed with narcolepsy who experiences cataplexy, is prescribed SXB, and was titrated to an efficacious and tolerable total dose of 9 g per night. She has a 4-year-old daughter. On nights when her husband travels, she wants to be able to wake up if her daughter needs her during the night and be alert in the morning to care for her child.	Change strength of dose(s)	18 (72)
	Change number of dose(s)	7 (28)
	Change timing of dose(s)	5 (20)
	Skip SXB	4 (16)
	Lifestyle change/nonmedical	3 (12)
	Discontinue SXB	1 (4)
Vignette 4:
Paul is a male college student with narcolepsy who experiences cataplexy, is prescribed SXB, and was titrated to an efficacious and tolerable total dose of 7.5 g per night. He has just turned 21 and would like to be able to go out late with friends and drink alcohol occasionally.	Lifestyle change/avoid alcohol	11 (44)
	Change strength of dose(s)	11 (44)
	Skip SXB	9 (36)
	Change timing of dose(s)	6 (24)
	Change number of dose(s)	4 (16)

Note: ^aRecommendation categories are not mutually exclusive.

Abbreviations: n, number; SXB, sodium oxybate.

Table 2 Physician and Practice Characteristics

Characteristics	Number of Physicians
Sample, N	25
Primary specialty, n (%)
Neurology	13 (52)
Psychiatry	11 (44)
Neuropsychiatry	1 (4)
Type of practice setting, n (%)
Academic hospital	6 (24)
Regional or community hospital/clinic	4 (16)
Office-based practice	15 (60)
Years in practice, mean (SD)	16 (8)
Number of patients with narcolepsy treated since being in practice, mean (SD)	197 (130)
Number of patients currently treated with SXB, mean (SD)	25 (27)
Number of patients with narcolepsy type 1 treated in past 12 months, mean (SD)	32 (27)
Number of patients with narcolepsy type 2 treated in past 12 months, mean (SD)	37 (25)

Abbreviations: n, number; SD, standard deviation; SXB, sodium oxybate.

Figure 1 Physician-reported percentages of patients with once-, twice-, and thrice-nightly oxybate dosing regimens.

Figure 2 Patients with equal and unequal oxybate dosing.

Figure 3 Circumstances discussed with patients regarding dose adjustments. *Only respondents who answered “Yes” to whether or not they discussed dose adjustment with patients received this question.

Figure 4 Types of individualized dosing guidance considered by physicians.

Figure 5 Importance of the ability to adjust oxybate dosing to accommodate occasional changes in a patient’s typical routine. 5 = very important; 1 = not at all important.

Figure 6 Impact of the ability to vary oxybate dosing regimen on the ability to provide care for your patients.