Real-World Preventive Effects of Suvorexant in Intensive Car
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This study aimed to examine the effects of suvorexant on delirium prevention in a real-world setting. Previous studies have demonstrated the efficacy of suvorexant for delirium prevention in limited randomized clinical trial settings; however, its effectiveness in everyday clinical settings remains unknown.

A single-center, retrospective cohort study was conducted in the ICU of an academic hospital. Patients (aged more than 3 years) admitted for 2 years were eligible if they stayed in the ICU for at least 72 hours. Suvorexant was prescribed by the attending physician for insomnia as part of everyday clinical practice. A Cox proportional hazards regression analysis was conducted on delirium-free survival for suvorexant users, adjusting for delirium-related covariates. As part of routine clinical practice, the Confusion Assessment Method for the Intensive Care Unit was used to detect the existence of delirium at least twice daily throughout the intensive care unit stay.

There were 699 patients—84 suvorexant users and 615 suvorexant nonusers. Delirium was detected in 214 patients. Delirium prevalence was significantly lower in suvorexant users than in nonusers (17.9% vs 32.4%, respectively). Cox regression analysis revealed a significantly lower hazard ratio (0.472; 95% CI, 0.268–0.832) of delirium in suvorexant users than in nonusers. Trazodone also had a preventive effect on delirium (hazard ratio 0.345; 95% CI, 0.149–0.802).

The present study extends to real-world settings previous findings that suvorexant is effective for delirium prevention.