Solriamfetol is likely superior to armodafinil–modafinil and pitolisant for reducing excessive daytime sleepiness (EDS) for patients with [obstructive sleep apnea (OSA)] already on conventional therapy, authors of a systematic review and network meta-analysis of 14 trials of 3,085 patients conclude. Evaluation of the comparative efficacy and safety also showed a probable increase in the risk for discontinuation of armodafinil–modafinil and may increase the risk for discontinuation with solriamfetol.
“At 4 weeks, compared with placebo, solriamfetol improves [Epworth Sleepiness Scale (ESS)] scores (mean difference [MD], −3.85 [95% CI, −5.24 to −2.50]; high certainty), and armodafinil–modafinil (MD, −2.25 [CI, −2.85 to −1.64]; moderate certainty) and pitolisant–H3-autoreceptor blockers (MD, −2.78 [CI, −4.03 to −1.51]; moderate certainty) probably improve ESS scores,” the researchers report. “At 4 weeks, compared with placebo, solriamfetol (standardized mean difference [SMD], 0.9 [CI, 0.64 to 1.17]) and armodafinil–modafinil (SMD, 0.41 [CI, 0.27 to 0.55]) improve [Maintenance of Wakefulness Test (MWT)] (both high certainty), whereas pitolisant–H3-autoreceptor blockers probably do not (moderate certainty). At 4 weeks, armodafinil–modafinil probably increases the risk for discontinuation due to adverse events (relative risk [RR], 2.01 [CI, 1.14 to 3.51]; moderate certainty); solriamfetol may increase the risk for discontinuation due to adverse events (RR, 2.07 [CI, 0.67 to 6.25]; low certainty). Low certainty evidence suggests these interventions may not increase the risk for serious adverse events.”