QUVIVIQ (daridorexant) – Europe’s first dual orexin receptor antagonist – is
now available for patients with chronic insomnia disorder in Italy and Germany
QUVIVIQ™ is indicated for the treatment of adult patients with insomnia
characterized by symptoms present for at least three months and considerable
impact on daytime functioning The availability of QUVIVIQ, Europe's first dual
orexin receptor antagonist, in Italy and Germany, offers a new targeted
mechanism of action that decreases overactive wakefulness in chronic insomnia
disorder
Allschwil, Switzerland – November 15 , 2022
Idorsia Ltd (SIX: IDIA) today announced that QUVIVIQ™ (daridorexant) is now
available in the first European countries, Italy and Germany, for the treatment
of adult patients with insomnia characterized by symptoms present for at least
three months and considerable impact on daytime functioning. 1 Chronic insomnia
disorder is one of the most prevalent sleep disorders in Europe, affecting
between 6%-12% of the adult population, 2 and impacting both physical and
mental health. 3 , 4
QUVIVIQ is the first dual orexin receptor antagonist (DORA) to be available to
patients in Italy and Germany for the treatment of chronic insomnia disorder.
Rather than inducing sleep through broad inhibition of brain activity, QUVIVIQ
blocks only the activation of orexin receptors. 1 Consequently, QUVIVIQ
decreases the wake drive, allowing sleep to occur, without altering the
proportion of sleep stages. 1
The recommended dose of QUVIVIQ is one tablet of 50 mg once per night, taken
orally in the evening within 30 minutes before going to bed. 1 In certain
circumstances, such as patients with moderate hepatic impairment or who are
taking moderate CYP3A4 inhibitors, the recommended dose is 25 mg once per
night. 1
Jean-Paul Clozel, MD and Chief Executive Officer, commented:
“We are determined to revolutionize the treatment of chronic insomnia disorder
and advance the science of sleep around the globe. QUVIVIQ which is now the
first dual orexin receptor antagonist available to patients in Europe, is the
result of more than 20 years of research in our labs. I am very happy that
Italian and German patients can now benefit from the targeted mechanism of this
drug. The unique characteristics of QUVIVIQ, notably with the 50 mg dose, offer
patients with chronic insomnia disorder not only a better night sleep, both in
terms of sleep onset and duration, but also an improvement in daytime
functioning.”
Simon Jose, Chief Commercial Officer of Idorsia, commented:
“We see a significant opportunity for QUVIVIQ as the first and only dual
orexin receptor antagonist available to the millions of patients suffering from
chronic insomnia disorder in Europe. There are very different payer
environments in Europe, as well as different approaches to the treatment of
insomnia across countries, and we have developed innovative, country-specific
strategies to make QUVIVIQ a success in each market. Physicians and patients
across Europe have told us that they are very excited by the prospect of what
QUVIVIQ can bring to the treatment of this debilitating condition. The Idorsia
teams are engaging with payers and physicians to explain the growing evidence
that demonstrates the unique value of QUVIVIQ and what it can bring to patients
and to society.”
The Phase 3 results – published in The Lancet Neurology – demonstrated that at
the recommended dose, QUVIVIQ improved sleep onset, sleep maintenance and
self-reported total sleep time in adults with chronic insomnia disorder. 5 A
major focus of the trials was to evaluate the impact of QUVIVIQ on daytime
functioning in patients with insomnia disorder, as assessed by IDSIQ, a
patient-reported outcomes instrument specifically developed and validated
according to FDA guidelines, to measure daytime functioning in patients with
insomnia. The recommended dose of QUVIVIQ demonstrated highly statistically
significant improvement in the daytime sleepiness domain of IDSIQ, which means
patients reported feeling less mentally and physically tired, less sleepy and
more energetic during the day, at months one and three compared to placebo,
with a favorable safety profile. 1 ,5 In clinical trials, the most frequently
reported adverse reactions were headache and somnolence. 1 The majority of
adverse reactions were mild to moderate in intensity. 1 No evidence of a
dose-relationship for the frequency or severity of adverse reactions was
observed. 1 The adverse reaction profile in elderly patients was consistent
with younger patients. 1 Somnolence was reported in 3% and 2% of patients
treated with QUVIVIQ 25 mg and 50 mg, respectively, compared to 2% of subjects
on placebo. 1 The marketing authorization was also supported by a long-term
follow-up extension study, which together with the pivotal trials, provides
clinical data for up to 12 months of continuous treatment. 1
For more information on the marketing authorization of QUVIVIQ in the European
Union, please review the Summary of Product Characteristics (SmPC) .
About QUVIVIQ (daridorexant) in chronic insomnia disorder
Studies over the past decades have shown that hyperarousal processes in the
brain play a key role in the pathology of insomnia. 6 Chronic insomnia disorder
is the result of continued brain hyperarousal that requires sustained
management with therapy suitable for daily use over months. 7 Orexin is a
neuropeptide, a small protein-like molecule, produced by the brain that
promotes wakefulness. 1 , 6 QUVIVIQ reduces nocturnal hyperarousal to improve
sleep (onset and maintenance) without next-morning residual effects in insomnia
patients, and thus improve daytime functioning. 5
Regulatory status of daridorexant
QUVIVIQ was approved by the US Food and Drug Administration (FDA) in January
2022, and subsequently made commercially available in May 2022. For more
information about QUVIVIQ in the US, see the Full Prescribing Information (PI
and Medication Guide). In April 2022, marketing authorization of QUVIVIQ was
granted by the European Commission and subsequently by the Medicines and
Healthcare products Regulatory Agency (MHRA) in Great Britain via the European
Commission Decision Reliance Procedure. For more information about QUVIVIQ in
the EU, see the Summary of Product Characteristics (SmPC) . Launch preparations
are underway in the major European markets and QUVIVIQ was made available in
both Italy and Germany in November 2022. Daridorexant is currently under review
with Swissmedic and Health Canada.
Notes to the editor
A bout insomnia disorder
Insomnia disorder is defined as difficulty initiating or maintaining sleep,
causing clinically significant distress or impairment in important areas of
daytime functioning. 3 This impact on sleep quantity or quality should be
present for at least three nights per week, lasts for at least three months,
and occurs despite an adequate opportunity to sleep. 3
Insomnia is a condition of overactive wake signaling and studies have shown
that areas of the brain associated with wakefulness remain more active during
sleep in patients with insomnia. 8 , 9 It is a common problem with an estimated
prevalence in Europe of 6-12% of the adult population. 2
Insomnia as a disorder is quite different from a brief period of poor sleep,
and it can take its toll on both physical and mental health. 4 It is a
persistent condition with a negative impact on daytime functioning. 3 Idorsia’s
research has shown that poor quality sleep can affect many aspects of daily
life, including the ability to concentrate, mood, and energy levels.
The goal of treatments for insomnia is to improve sleep quality and quantity,
as well as daytime functioning, while avoiding adverse events and next-morning
residual effects. 5 Current recommended treatment of insomnia includes sleep
hygiene therapy, cognitive behavioral therapy, and pharmacotherapy. 6
About the orexin system
Wake and sleep signaling is regulated by intricate neural circuitry in the
brain. One key component of this process is the orexin system, which helps
promote wakefulness. 5 , 7 , 10 There are two forms of orexin neuropeptides –
small protein-like molecules used by nerve cells (neurons) to communicate with
each other in the brain – orexin A and orexin B. 7 Orexin promotes wakefulness
through its receptors OX1R and OX2R. 7 Together, these neuropeptides and
receptors make up the orexin system. The orexin system stimulates targeted
neurons in the wake system – leading to the release of several chemicals
(serotonin, histamine, acetylcholine, norepinephrine) – to promote wakefulness.
11 Under normal circumstances, orexin levels rise throughout the day as
wakefulness is promoted and then fall at night. 12 Overactivity of the wake
system is an important driver of insomnia. 5 , 10
The daridorexant Phase 3 registration program
The Phase 3 registration program comprised two three-month studies, together
with a long-term double-blind extension study. 1 The program enrolled a total
of 1,854 patients with insomnia disorder. 1 As insomnia often presents later in
life, and older adults are more susceptible to experience fragmented sleep,
early awakening and daytime sleepiness, 13 around 40% of the recruited
population was at least 65 years of age. 5
The placebo-controlled studies investigated the effects of three doses of
daridorexant (10 mg, 25 mg, and 50 mg) on sleep and daytime functioning
parameters, objectively in a sleep lab by polysomnography and subjectively with
a daily patient diary at home. 5 The impact of insomnia on patients’ daytime
functioning was measured daily using the sleepiness domain score from the
Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ © ) – a
patient-reported outcome (PRO) instrument developed and validated according to
the FDA Guidance for Industry. 5
More than 800 patients continued treatment in the 40-week extension study,
which measured the effect of all three doses vs. placebo, generating data for
long-term treatment of insomnia disorder. 14
Phase 3 data has been reported in The Lancet Neurology: The pivotal studies
demonstrated that daridorexant 50 mg significantly improved sleep onset, sleep
maintenance and self-reported total sleep time at months one and three compared
to placebo. 5 The largest effect was observed with the highest dose (50 mg),
followed by 25 mg, while the 10 mg dose did not have a significant effect. 5 In
all treatment groups the proportions of sleep stages were preserved, in
contrast to findings reported with benzodiazepine receptor agonists. 5
A major focus of the trials was to evaluate the impact of daridorexant on
daytime functioning in patients with insomnia disorder, as assessed by the
IDSIQ. 5 IDSIQ is a patient-reported outcomes instrument specifically developed
and validated according to FDA guidelines, to measure daytime functioning in
patients with insomnia. 15 The sleepiness domain score of the IDSIQ was
evaluated as a key secondary endpoint in both pivotal studies and comparisons
to placebo included type I error control for multiplicity. 5 Daridorexant 50 mg
demonstrated highly statistically significant improvement in daytime sleepiness
at month one and month three. 5 The sleepiness domain score was not
significantly improved on 25 mg in either study at either timepoint. 5
The overall incidence of adverse events was comparable between treatment
groups. 1 The most frequently reported adverse reactions were headache and
somnolence and, overall, the majority of adverse reactions were mild to
moderate in intensity. 1 There was no evidence of dose-dependent increases in
adverse events across the dosing range. 1 Further, no dependence, rebound
insomnia or evidence of abuse or withdrawal symptoms indicative of physical
dependence upon treatment discontinuation was observed in clinical studies. 1
Contraindications Hypersensitivity to daridorexant or any of the excipients
Narcolepsy Concomitant use with strong CYP3A4 inhibitors
Warnings and precautions for use
Use with caution in elderly patients because of the general risk of falls.
Efficacy and safety data in patients >75 are limited.
Patients should be cautioned about drinking alcohol during treatment.
Sleep paralysis and hypnagogic/hypnopompic hallucinations can occur, mainly
during the first weeks of treatment. Symptoms similar to mild cataplexy have
been reported with dual orexin receptor antagonists. Prescribers should explain
this to patients and should consider discontinuing in case events occur.
Use with caution in patients exhibiting symptoms of depression.
Use with caution in patients with psychiatric co-morbidities due to limited
efficacy and safety data.
Daridorexant did not have significant respiratory effects in patients with
mild or moderate OSA or moderate COPD. In the absence of data, use with caution
in patients with severe OSA and severe COPD.
There was no evidence of abuse or withdrawal symptoms indicative of physical
dependence upon treatment discontinuation in clinical studies with daridorexant
in subjects with insomnia. Because individuals with a history of abuse or
addiction to alcohol or other substances may be at increased risk for abuse of
QUVIVIQ, these patients should be followed carefully.
Use is not recommended in patients with severe hepatic impairment.
Effects on availability to drive and use machines
Patients should be cautioned about engaging in potentially hazardous
activities, driving, or operating heavy machinery unless they feel fully alert,
especially in the first few days of treatment. In order to minimize this risk,
a period of approximately 9 hours is recommended between taking QUVIVIQ and
driving or using machines.
References
1 QUVIVIQ TM Summary of Product Characteristics. 2022.
2 Riemann, D., et al. Sleep. 2017;26(6):675-700.
3 The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5;
American Psychiatric Association, 2013).
4 Wardle-Pinkston S., et al. Sleep Med Rev. 2019;48.
5 Mignot, E., et al. Lancet Neurol. 2022;21:125–39.
6 Muehlan, C., et al. Expert Opin. Drug Metab. Toxicol. 2020;16(11):1063–1078.
7 Muehlan, C., et al. J Psychopharmacol. 2020;34(3):326-335.
8 Buysse, D.J., et al. Drug Discov Today Dis Models. 2011;8(4):129-137.
9 Levenson, J.C., et al. Chest. 2015;147(4):1179-1192.
10 Boof, M.L., et al. Eur J Clin Pharmacol. 2019;75(2):195-205.
11 Clifford, B.S., et al. Trends Neurosci. 2001;24(12).726-31.
12 Gotter, A.L., et al. BMC Neuroscience. 2013;14(1):14-19.
13 Patel, D., et al. J Clin Sleep Med. 2018;14(06):1017–1024.
14 Data on file, Idorsia.
15 Hudgens, S., et al. Patient. 2020. doi:10.1007/s40271-020-00474-z.
IDSIQ © 2020, University of Pittsburg. All rights reserved. IDSIQ-14
derivative created 2020 by Idorsia Pharmaceuticals Ltd under license and
distributed by Idorsia Pharmaceuticals Ltd under license. IDSIQ is further a
registered trademark of Idorsia Pharmaceuticals Ltd.
About Idorsia
Idorsia Ltd is reaching out for more – We have more ideas, we see more
opportunities and we want to help more patients. In order to achieve this, we
will develop Idorsia into a leading biopharmaceutical company, with a strong
scientific core.
Headquartered near Basel, Switzerland – a European biotech-hub – Idorsia is
specialized in the discovery, development and commercialization of small
molecules to transform the horizon of therapeutic options. Idorsia has a broad
portfolio of innovative drugs in the pipeline, an experienced team of
professionals covering all disciplines from bench to bedside, state-of-the-art
facilities, and a strong balance sheet – the ideal constellation to translate
R&D efforts into business success.
Idorsia was listed on the SIX Swiss Exchange (ticker symbol: IDIA) in June
2017 and has over 1,200 highly qualified specialists dedicated to realizing our
ambitious targets.
For further information, please contact
Andrew C. Weiss
Senior Vice President, Head of Investor Relations & Corporate Communications
Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, CH-4123 Allschwil
+41 58 844 10 10
investor.relations@idorsia.com – media.relations@idorsia.com – www.idorsia.com
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