Narcolepsy Drugs: Which One Is the Best?

While there is no significant difference between the efficacy of sodium oxybate, modafinil, and pitolisant in the treatment of narcolepsy, the latter does have the best overall medical benefit, according to a new meta-analysis.

The researchers came to this conclusion after comparing the safety and efficacy of 3 drug treatments and 6 doses: sodium oxybate (6 g/d, and 9 g/d), modafinil (between 200 and 400 mg/d), and pitolisant (up to 20 mg/d, and up to 40 mg/d).

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The safety and efficacy of each had been previously determined through 14 randomized controlled trials. Of those studies, 12 had significant heterogeneity (>50%) for almost all endpoints, but between-design consistency was present.

The researchers of the new analysis found that the drug treatments had no significant difference in efficacy. However, pitolisant, 40 mg, did have the best P scores for the benefit/risk ratio, at 0.87.

Further, sodium oxybate, 9 g/d; modafinil; and pitolisant, up to 40 mg/d; had similar efficacy for both the Epworth Excessive Sleepiness Score and the Maintenance of Wakefulness Test.

In reducing cataplexy, pitolisant, 40 mg/d, and sodium oxybate, 9 g/d, in 2 nightly doses were found to have similar efficacy.

Modafinil, 200 to 400 mg/d; sodium oxybate, 9 g/d; and pitolisant, up to 40 mg/d; had similar efficacy in reducing excessive daytime sleepiness.

And with the exception of oxybate, 9 g/d, a good safety profile characterized by a treatment-emergent adverse event incidence risk ratio of less than 1.5 was found for all treatments.

—Colleen Murphy

Reference:

Lehert P, Falissard B. Multiple treatment comparison in narcolepsy: a network meta-analysis. Sleep. 2018;41(12):zsy185. https://doi.org/10.1093/sleep/zsy185.