Solriamfetol for the treatment of daytime sleepiness in obstructive sleep apnea

ABSTRACT

Introduction: Obstructive sleep apnea (OSA) is highly prevalent and constitutes a major health hazard. Current pharmacotherapy is ineffective in correcting sleep-disordered breathing and is used adjunctively to address residual sleepiness. A new drug, solriamfetol, a selective norepinephrine-dopamine reuptake inhibitor, is the first drug of its class that is being considered by the US Food and Drug Administration (FDA) to treat excessive sleepiness in OSA and narcolepsy patients.

Areas covered: This review covers drug chemistry, pharmacodynamics, pharmacokinetics, and metabolism of solriamfetol. Results of three Phase 3 trials, Treatment of OSA and Narcolepsy Excessive Sleepiness (TONES 3, 4, 5), relevant to OSA patients are summarized. Published abstracts/articles and a 2017 Jazz Investor Presentation provided data. Databases searched included PubMed, Google Scholar, Lexi-Comp, Scopus, Science, and Ovid.

Expert commentary: Solriamfetol shows promise as adjunctive therapy in OSA. It is well tolerated and effective in reducing sleepiness and is an alternative to modafinil or armodafinil. Unlike stimulants like methylphenidate or dextroamphetamine, it does not have cardiac effects, rebound hypersomnia, or withdrawal effects.

KEYWORDS:

• Excessive sleepiness
• obstructive sleep apnea
• solriamfetol

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Information resources

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2. Investigational solriamfetol may improve multiple sleep measures. (Internet). Cited September 30, 2018. Available from https://www.mdedge.com/chestphysician/article/169655/pulmonology/investigational-solriamfetol-may-improve-multiple-sleep

3. Excessive sleepiness (ES) in OSA: Identifying ES in the Clinical Interview. Cited September 30, 2018. Available from https://www.esandosa.com/identify-es-osa-clinical-interview.pdf

4. The latest treatments for OSA. Cited September 30, 2018Available from https://www.sleepfoundation.org/sleep-disorders-problems-list/the-latest-treatments-obstructive-sleep-apnea

5. Pepin JL. Evaluation and management of residual sleepiness in obstructive sleep apnea. Collop N, Scammell T, Finlay G, Eds. UptoDate. Waltham, MA: Upto Date Inc. http://www.uptodate.com(Accessed on May 02, 2018).

Additional information

Funding

This paper was not funded.