Psychiatrists ascribe the highest level of unmet need in insomnia treatment to be for new therapies with a reduced risk of abuse and tolerance, according to a recent Decision Resources Group’s report on insomnia.

“The potential for a patient to develop abuse and tolerance with insomnia medications is a concern among interviewed psychiatrists, who take this risk into consideration when prescribing an insomnia therapy,” says Decision Resources Group analyst Tamara Blutstein, PhD, in a release. “Reduced risk for tolerance or dependence is an area where surveyed payers express a high willingness to grant favorable formulary status for a new insomnia therapy and where surveyed physicians identify unmet need in insomnia treatment.”

Other key findings from the DecisionBase report entitled Insomnia: In the Highly Genericized Insomnia Market, What Opportunities Remain for New Therapies?:

  • Lunesta and Suvorexant: Based on clinical data and the opinions of interviewed thought leaders, suvorexant (Merck & Co.’s MK-4305) has clinical advantages over Lunesta (Dainippon Sumitomo/Sunovion Pharmaceuticals/Eisai) in terms of safety and tolerability, specifically a lower incidence of psychomotor events and residual next-day effects at the doses deemed approvable.
  • Unmet need: In addition to the need for a therapy bearing a reduced risk of abuse and tolerance, surveyed psychiatrists identify significant unmet need for therapies associated with reduced residual next-day side effects, such as residual sedation. This finding is consistent with insight from interviewed sleep experts, who call for a novel insomnia medication with a more favorable pharmacokinetic profile, in turn reducing the frequency of next-day side effects. “The longer the half-life of a drug, the more effective it is at addressing sleep maintenance insomnia; unfortunately, the more likely it is to harbor residual next-day side effects. Interviewed psychiatrists note that no available insomnia therapies offer patients the ideal balance of a full night sleep without next-day impairment,” Blutsein says.
  • Formulary inclusion: Surveyed US managed care organization pharmacy directors are receptive to reimbursing a novel insomnia therapy offering improvements in time awake after sleep onset and in the number of patients reporting next-day sleepiness, but they would require 100% or more improvement in these metrics over that attained by current therapies. Therapies offering such robust benefits could nevertheless command a premium price in this market but payers would control costs by requiring step therapy and prior authorization.