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. 2023 Apr 20;23(1):278.
doi: 10.1186/s12888-023-04683-2.

Hypnotic prescription trends and patterns for the treatment of insomnia in Japan: analysis of a nationwide Japanese claims database

Shoki Okuda  1 , Zaina P Qureshi  2 , Yukiko Yanagida  3 , Chie Ito  4 , Yuji Homma  4 , Shigeru Tokita  3
Affiliations

Hypnotic prescription trends and patterns for the treatment of insomnia in Japan: analysis of a nationwide Japanese claims database

Shoki Okuda et al. BMC Psychiatry. .

Abstract

Background: There is limited consensus regarding the optimal treatment of insomnia. The recent introduction of orexin receptor antagonists (ORA) has increased the available treatment options. However, the prescribing patterns of hypnotics in Japan have not been comprehensively assessed. We performed analyses of a claims database to investigate the real-world use of hypnotics for treating insomnia in Japan.

Methods: Data were retrieved for outpatients (aged ≥ 20 to < 75 years old) prescribed ≥ 1 hypnotic for a diagnosis of insomnia between April 1st, 2009 and March 31st, 2020, with ≥ 12 months of continuous enrolment in the JMDC Claims Database. Patients were classified as new or long-term users of hypnotics. Long-term use was defined as prescription of the same mechanism of action (MOA) for ≥ 180 days. We analyzed the trends (2010-2019) and patterns (2018-2019) in hypnotics prescriptions.

Results: We analyzed data for 130,177 new and 91,215 long-term users (2010-2019). Most new users were prescribed one MOA per year (97.1%-97.9%). In 2010, GABAA-receptor agonists (benzodiazepines [BZD] or z-drugs) were prescribed to 94.0% of new users. Prescriptions for BZD declined from 54.8% of patients in 2010 to 30.5% in 2019, whereas z-drug prescriptions remained stable (~ 40%). Prescriptions for melatonin receptor agonist increased slightly (3.2% to 6.3%). Prescriptions for ORA increased over this time from 0% to 20.2%. Prescriptions for BZD alone among long-term users decreased steadily from 68.3% in 2010 to 49.7% in 2019. Prescriptions for ORA were lower among long-term users (0% in 2010, 4.3% in 2019) relative to new users. Using data from 2018-2019, multiple (≥ 2) MOAs were prescribed to a higher proportion of long-term (18.2%) than new (2.8%) users. The distribution of MOAs according to psychiatric comorbidities, segmented by age or sex, revealed higher proportions of BZD prescriptions in elderly (new and long-term users) and male (new users) patients in all comorbidity segments.

Conclusion: Prescriptions for hypnotics among new and long-term users in Japan showed distinct patterns and trends. Further understanding of the treatment options for insomnia with accumulating evidence for the risk-benefit balance might be beneficial for physicians prescribing hypnotics in real-world settings.

Keywords: Benzodiazepine; Claims database; Hypnotics; Insomnia; Japan; Melatonin receptor antagonist; Orexin receptor antagonist; Prescriptions; z-drugs.

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Conflict of interest statement

SO, YY, and ST are employees of MSD K.K., Tokyo, Japan, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and may own stock and/or hold stock options in Merck & Co., Inc., Rahway, NJ, USA. ZPQ was an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and may have owned stock and/or stock options in Merck & Co., Inc., Rahway, NJ, USA at the time of the study. YH is an employee of JMDC Inc. and CI was an employee of JMDC Inc. at the time of the study.

Figures

Fig. 1
Fig. 1
Patient flow diagram and identification of new and long-term users. The patient population in each box represents the cumulative number of patients in each analysis period
Fig. 2
Fig. 2
Trends in prescribed hypnotics (a) and distribution of baseline hypnotics (b) among new users. The trends in hypnotics prescribed between 2010 and 2019 (a) and the distribution of hypnotics prescribed in 2018–2019 (b) were assessed in new users of hypnotics. *The denominator was the number of patients prescribed BZDs (all BZDs were regarded as a single MOA regardless of the type). †The denominator was the number of patients prescribed multiple MOAs. BZD benzodiazepine, MOA mechanism of action, MRA melatonin receptor agonist, ORA orexin receptor antagonist, z-drug non-benzodiazepine
Fig. 3
Fig. 3
Distribution of hypnotics segmented by psychiatric comorbidities and age (a) and sex (b) among new users of hypnotics. The distributions of hypnotics prescribed to new users of hypnotics in 2018–2019 were segmented according to psychiatric comorbidities × age (a) and psychiatric comorbidities × sex (b). Values are % of patients. Neurocognitive disorders = Alzheimer’s disease. BZD benzodiazepine, MOA mechanism of action, MRA melatonin receptor agonist, ORA orexin receptor antagonist, z-drug non-benzodiazepine
Fig. 4
Fig. 4
Trends in prescribed hypnotics (a) and distribution of baseline hypnotics (b) among long-term users. The trends in hypnotics prescribed between 2010 and 2019 (a) and the distribution of hypnotics prescribed in 2018–2019 (b) were assessed in long-term users of hypnotics. *The denominator was the number of patients prescribed BZDs (all BZDs were regarded as a single MOA regardless of the type). †The denominator was the number of patients prescribed multiple MOAs. BZD benzodiazepine, MOA mechanism of action, MRA melatonin receptor agonist, ORA orexin receptor antagonist, z-drug non-benzodiazepine
Fig. 5
Fig. 5
Distribution of hypnotics segmented by psychiatric comorbidities and age (a) and sex (b) among long-term users of hypnotics. The distributions of hypnotics prescribed to long-term users of hypnotics in 2018–2019 were segmented according to psychiatric comorbidities × age (a) and psychiatric comorbidities × sex (b). Values are % of patients. Neurocognitive disorders = Alzheimer’s disease. BZD benzodiazepine, MOA mechanism of action, MRA melatonin receptor agonist, ORA orexin receptor antagonist, z-drug non-benzodiazepine
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References

    1. Morin CM, Drake CL, Harvey AG, Krystal AD, Manber R, Riemann D, et al. Insomnia disorder. Nat Rev Dis Primers. 2015;1:15026. doi: 10.1038/nrdp.2015.26. - DOI - PubMed
    1. Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–133. doi: 10.7326/m15-2175. - DOI - PubMed
    1. Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675–700. doi: 10.1111/jsr.12594. - DOI - PubMed
    1. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(2):307–349. doi: 10.5664/jcsm.6470. - DOI - PMC - PubMed
    1. Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol. 2010;24(11):1577–1601. doi: 10.1177/0269881110379307. - DOI - PubMed

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