Comparative Efficacy and Safety of Dual Orexin Receptor Antagonists (DORAs) Versus Z-Drugs for Insomnia in Older Adults : A Systematic Review

Vollständiger Abstract

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Introduction Insomnia affects up to 48% of older adults globally, often treated with Z-drugs that increase the risk of cognitive impairment and falls.1,4 Dual Orexin Receptor Antagonists (DORAs) offer a targeted alternative by specifically suppressing wakefulness-promoting pathways to minimize these adverse effects.7,8 Method This systematic review of Randomized Controlled Trials was conducted using the PRISMA guideline with references found in multiple online databases including PubMed, ScienceDirect, Proquest and Sage Journals. The search strategy utilized a combination of keywords relevant to this study and the screening process was conducted by implementing exclusion and inclusion criteria developed using the PRISMA guideline.9 The studies recovered were then assessed by the Cochrane RoB 2 risk of bias tool.12 Result Seven RCTs were evaluated. DORAs demonstrated significantly superior efficacy over Z-drugs, with Least Squares Mean differences of -6.7 and -8.0 minutes for 5 mg and 10 mg doses, respectively.14 Furthermore, safety analyses revealed DORAs had a significantly lower relative incidence of residual effects and cognitive impairment (15%).16 Conclusion Although both DORAs and Z-drugs help mitigate insomnia symptoms, DORAs have shown lesser adverse side effects in the treatment regimen, most notably in safety, DORAs have also shown lower levels of falls during treatment. Heterogeneity still is a limitation and restricts data power, standardized studies are needed to show a more comprehensive outcome in studies.