Once-Nightly Sodium Oxybate for Narcolepsy - Episode 5
Important next steps studying once-nightly sodium oxybate and other therapies for narcolepsy treatment.
Clete Kushida, MD, PhD: So, Lois, what do you think are some important next steps?
Lois E. Krahn, MD: Well, I really appreciate having this evidence to incorporate into my clinical practice. There are a number of new medications for the treatment of narcolepsy, and this will give me the opportunity to understand what my patients needs are, and then to select a medication that best reflects their needs. And for this medication, I do think that the once-a-night dosing is going to be something welcomed by many patients and their families. So just having more choices is very welcome. Now we have the opportunity to clarify in the clinical practice setting which medications are best for which patients. I do want to say 1 other thing that was pointed out in this paper, which I think is good practice for patients with any type of sleep problem. In order to help a person not have enuresis, remind them to be careful about their fluid intake at bedtime, and to empty their bladder before they go to bed is a good practice. I encourage that for patients with a variety of sleep disorders, but that was 1 point made in this paper to help with the side effects of enuresis that I will also pass on to all my patients with sleep disorders, but especially those on oxybate therapy.
Clete Kushida, MD, PhD: Thank you, Lois. One additional point that was pointed out in the article was that the study concentrated on the grouping of narcolepsy, both NT1 [narcolepsy type-1] and NT2 [narcolepsy type-2]. But it would be interesting to explore the effects of the once-nightly sodium oxybate on the end points that were studied, looking at it in a subgroup analysis—looking at NT1 versus NT2—and also in subgroups of patients who were, or were not, receiving concomitant stimulant medication. Also, 1 thing that would be interesting is that looking at the pharmacokinetic profile of this once-nightly sodium oxybate, it’s striking that it kind of mimics sleep depth, whereas most of the deep sleep, the N3 sleep is in the first part of the night, and then it tapers down. So, it would be nice to really explore that profile or that type of sleep architecture.
Lois E. Krahn, MD: I very much agree. We know that these medications improve sleep quality, likely by increasing N3 sleep. And to just gain a deeper understanding of how that works and how it benefits patients, with it being a once-a-night formulation it will be more straightforward to look at that without worrying about the timing of the second dose. I also hope from a patient perspective that we can increasingly understand how valuable this is for patients who come to us. And some of their initial concerns are not so much about excessive daytime sleepiness and cataplexy, although those will be part of the picture for a patient with narcolepsy. But those that say, “I keep waking up at night and I have terrible scary dreams,” I suspect like all oxybate therapy that the once-a-night form will be particularly beneficial to that group of patients. So, I look forward to the subgroup analysis as the data becomes available.
Clete Kushida, MD, PhD: Thank you for joining us for this PsychTimes Between the Lines presentation, and both Dr Lois Krahn and I sincerely hope that you’ll be able to incorporate some of the content that we discussed during this presentation into your clinical practice. Thank you very much.
Transcript edited for clarity.