Original Research J Clin Psychiatry October 2023

Lemborexant and Daridorexant for the Treatment of Insomnia: An Indirect Comparison Using Number Needed to Treat, Number Needed to Harm, and Likelihood to Be Helped or Harmed

JCP 2023;84(6):10.4088/JCP.23m14851

Full Article Read the complete peer-reviewed article in J Clin Psychiatry. Clinical Summary Patients with chronic insomnia often need medication when CBT-I is unavailable or insufficient, but clinicians lack head-to-head data to judge how newer dual orexin receptor antagonists compare in practice. This analysis translates trial results for lemborexant and daridorexant into NNT, NNH, and LHH metrics that are easier to use when weighing likely benefit against common adverse events. FAQ How did lemborexant and daridorexant compare for insomnia benefit in this indirect analysis?

Key Takeaways Across pooled subjective outcomes at month 1, lemborexant 5 mg and 10 mg produced NNT values versus placebo < 10 for ISI score < 10, ISI score ≤ 7, ISI score ≥ 6-point decrease from baseline, and sTST > 80-minute increase from baseline, whereas pooled daridorexant 25 mg and 50 mg had no NNT values versus placebo < 10. Clinical Guide How should clinicians use this indirect comparison to choose between lemborexant and daridorexant for adults with insomnia? Clinical Guide How should clinicians use this article's indirect evidence when deciding whether to start lemborexant at 5 mg and when to consider increasing to 10 mg for adult insomnia?