First presentation of top-line efficacy and
safety results from the Phase 4 DUET (Develop hypersomnia
Understanding by Evaluating low-sodium oxybate Treatment) trial of
adults with narcolepsy or idiopathic hypersomnia
For U.S. media and investors only
DUBLIN, Oct. 31,
2024 /PRNewswire/ -- Jazz Pharmaceuticals plc
(Nasdaq: JAZZ) today announced that eight abstracts presenting data
from across its sleep portfolio were featured at the 37th annual
Psych Congress, held in Boston
from October 29 through November 2,
2024. The data includes the top-line results of the Phase 4
DUET (Develop hypersomnia Understanding by Evaluating low-sodium
oxybate Treatment) trial, evaluating the effectiveness of
low-sodium oxybate on key sleep outcomes in adults with narcolepsy
or idiopathic hypersomnia (IH). Notably, these DUET data are the
first to show prospective improvements on excessive daytime
sleepiness (EDS), as well as key polysomnography (PSG) outcomes of
sleep disruption, among adults with narcolepsy treated with
Xywav® (calcium, magnesium, potassium, and sodium
oxybates) oral solution. Further, new DUET data evaluating
nighttime Xywav treatment in adults with IH demonstrate
clinical improvements on daytime symptoms, including sleep inertia
measured by the Patient Global Impression of Change
(PGIc).
The DUET trial is a Phase 4, prospective, single-arm, open-label
study to assess the effect of Xywav treatment on EDS,
polysomnography parameters, and functional outcomes in adults with
narcolepsy or IH. Observed adverse events were consistent with the
known safety profile of Xywav, with the most common
including nausea, dizziness and headache.
"The new DUET data presented today demonstrate the impact of
low-sodium Xywav treatment on key narcolepsy and idiopathic
hypersomnia symptoms," said Logan
Schneider, MD, adjunct clinical associate professor of sleep
medicine, Stanford Sleep Center and Consultant Neurologist,
Stanford/VA Alzheimer's Center. "These
data build on our confidence that appropriate treatment can
meaningfully impact the outcomes that matter to patients and their
functioning."
Presentation highlights include:
- Xywav DUET Narcolepsy Top-line Results
(P166): Novel analysis of primary and key secondary
outcomes in participants with narcolepsy show improvements in
daytime and nighttime symptoms with Xywav treatment compared
to baseline across daytime sleepiness and PSG-based measures of
sleep disruption, including sleep stage shifts from deeper to
lighter stages of sleep, time spent in deep sleep, and number of
awakenings. Specifically, the statistically significant change
(least square mean, standard error) from baseline on the Epworth
Sleepiness Scale (ESS) was −7.7 (0.9), P<0.0001, while changes
for total shifts from deeper to lighter stages of sleep, N3 sleep
(deep sleep) duration in minutes, and number of awakenings were
−13.1 (3.0), P<0.0001; 45.0 (8.8), P<0.0001; and −3.2 (0.9),
P=0.0015, respectively (N=34 each).
- Xywav DUET IH Top-line Results (P165): First
presentation of primary and key secondary outcomes in participants
with IH show Xywav treatment resulted in improvements in
EDS, measured by ESS and Idiopathic Hypersomnia Severity Scale
(IHSS). Additionally, improvements were observed across PGIc
measures of overall symptoms, with new data on sleep inertia
measured within the PGIc. Statistically significant changes (least
square mean, standard error) in ESS (N=40) and IHSS (N=36) from
baseline to end of treatment were −8.4 (0.7), P<0.0001 and −15.5
(1.5), P<0.0001, respectively. Most participants reported
improvement (very much, much, minimally) on the PGIc overall
(94.6%; N=37) and PGIc sleep inertia inventory (81.1%; N=37).
"These DUET data are the first to show Xywav's impact on
polysomnography measures of nighttime awakenings, sleep stage
shifts, and deep sleep for people living with narcolepsy, as well
as improvements among adults with IH in key outcomes important for
daily life," said Kelvin Tan, MBBCh,
MRCPCH, chief medical affairs officer of Jazz Pharmaceuticals.
"Jazz is committed to our leadership in sleep, as exemplified by
our presentations at Psych Congress of the DUET trial data, which
studied the effectiveness of low-sodium Xywav on symptoms of
narcolepsy and IH by demonstrating improvements in measures which
are key for patients to wake up more refreshed with improved
wakefulness during the day."
The Psych Congress 2024 presentations are available
on-demand through the conference mobile application. Abstracts and
posters will also be published on HMP Global's Psychiatry &
Behavioral Health Learning Network 30-60 days after the event
ends.
A full list of Jazz presentations follows below:
Presentation
Title
|
Presenting
Author
|
Poster
Number
|
Effectiveness and
Safety of Low-Sodium Oxybate in Participants With Narcolepsy:
Top-line Results From the Phase 4 DUET Study
|
L. Schneider
|
P166
|
Effectiveness and
Safety of Low-Sodium Oxybate in Participants With Idiopathic
Hypersomnia: Top-line Results From the Phase 4 DUET
Study
|
D. Nichols
|
P165
|
Efficacy and Safety of
Low-Sodium Oxybate in Participants With Idiopathic Hypersomnia With
or Without Psychiatric Comorbidities
|
S. Bronson
|
P83
|
A Conceptual Disease
Model of the Symptoms and Impacts of Idiopathic Hypersomnia From
the Patient Perspective
|
M. Whalen
|
P46
|
Understanding Sleep
Inertia: A Qualitative Study of the Patient Experience With
Idiopathic Hypersomnia
|
M. Whalen
|
P47
|
Qualitative Comparison
of the Patient Experience of Excessive Daytime Sleepiness in
Idiopathic Hypersomnia, Obstructive Sleep Apnea, and Major
Depressive Disorder
|
A. Cutler
|
P117
|
The Clinical and
Humanistic Burden of Idiopathic Hypersomnia in the United States:
Analysis of the National Health and Wellness Survey
|
J. Sacks
|
P35
|
Design Elements for a
Switch Study From High- to Low-Sodium Oxybate Evaluating Blood
Pressure in Narcolepsy (XYLO)
|
J. Alexander
|
P82
|
About Narcolepsy
Narcolepsy is a chronic, debilitating
neurologic sleep disorder characterized by excessive daytime
sleepiness (the inability to stay awake and alert during the day
resulting in the irrepressible need to sleep or unplanned lapses
into sleep or drowsiness), or EDS, and an inability to regulate
sleep-wake cycles normally.1 Patients with EDS due to
narcolepsy experience sleep attacks and, despite fighting the urge
to sleep, may unintentionally fall asleep for short
periods.2,3 These sleep attacks may happen at
inappropriate or potentially dangerous times such as during
driving, cycling, eating, or mid-conversation.4
There is no cure for narcolepsy, therefore this EDS is lifelong
and has a substantial negative impact on a person's ability to
function psychologically, socially and
professionally.5 Patients with narcolepsy are at
increased risk for hypertension, cardiometabolic
morbidity, stroke, myocardial infarction, heart failure,
cardiac arrest, and death.6,7,8,9 As narcolepsy is a
chronic condition that requires lifelong, nightly treatment, early
access to an effective, low-sodium treatment can transform lives
and reduce the impact of narcolepsy on a person's physical and
mental health.5
About Idiopathic Hypersomnia
Idiopathic
hypersomnia is an often debilitating, neurologic sleep disorder
that goes beyond chronic excessive daytime
sleepiness.10,11,12,13 Idiopathic hypersomnia is a
24-hour sleep disorder, and symptoms may include a prolonged but
non-restorative main (nighttime) sleep episode of more than 9
hours, or a sleep duration of 11 hours or longer over a 24-hour
period; cognitive impairment; long and unrefreshing naps; brain
fog, or the inability to focus for long periods of time; and severe
sleep inertia (prolonged difficulty waking, with frequent reentries
into sleep, confusion, and
irritability).10,11,12,13,14 Although there are
overlapping clinical features with narcolepsy, idiopathic
hypersomnia is a condition with its own specific diagnostic
criteria.13,15
Idiopathic hypersomnia is an often debilitating illness that can
significantly affect social, educational, and occupational
functioning.16,17 In the U.S., approximately
37,000 adult patients have been diagnosed with idiopathic
hypersomnia and are actively seeking
healthcare.18 This low number of people may be due
to the many difficulties in identifying and diagnosing idiopathic
hypersomnia, as well as distinguishing it from other similar sleep
disorders. It is estimated that far fewer patients are currently
receiving pharmacological treatment for their idiopathic
hypersomnia.18,19,20,21
About Xywav® (calcium, magnesium, potassium, and
sodium oxybates) oral solution
Xywav is the only
low-sodium oxybate approved by the U.S. Food and Drug
Administration (FDA) for the treatment of cataplexy or
excessive daytime sleepiness (EDS) in patients 7 years of age and
older with narcolepsy. The FDA recognized seven years of Orphan
Drug Exclusivity for Xywav for the treatment of
cataplexy or EDS in patients 7 years of age and older with
narcolepsy. The Office of Orphan Product Development (OOPD) at the
FDA also published its summary of clinical superiority findings
for Xywav for the treatment of cataplexy or EDS in
patients 7 years of age and older with narcolepsy by means of
greater cardiovascular safety compared to
Xyrem® (sodium oxybate) oral solution. The decision
of the OOPD is based on the FDA findings
that Xywav provides a greatly reduced chronic
sodium burden compared
to Xyrem. Xywav has 131 mg of sodium
at the maximum recommended nightly dose whereas other high
sodium oxybates have 1640 mg at the equivalent
dose. Xywav is comprised of a unique composition
of cations resulting in 92% less sodium, or a reduction of
approximately 1,000 to 1,500 mg/night at the recommended dose range
of 6 g to 9 g/night. Xywav is the only oxybate
therapy that does not carry a warning in the label related to use
in patients sensitive to high sodium intake.
Xywav is also the first and
only U.S. FDA-approved treatment option for idiopathic
hypersomnia in adults. The FDA recognized seven years of Orphan
Drug Exclusivity for Xywav for the treatment of
idiopathic hypersomnia in adults. Xywav is the
only FDA-approved treatment studied across the multiple symptoms of
idiopathic hypersomnia, such as EDS, sleep inertia (severe
grogginess or confusion when waking up), long sleep duration and
cognitive impairment. Xywav can be administered as
a twice- or once-nightly regimen for the treatment of idiopathic
hypersomnia in adults.
The exact mechanism of action of Xywav in the
treatment of adults with idiopathic hypersomnia and of cataplexy
and EDS in narcolepsy is unknown. It is hypothesized that the
therapeutic effects of Xywav are mediated through
GABAB actions during sleep at noradrenergic and
dopaminergic neurons, as well as thalamocortical
neurons.1 The U.S. Drug Enforcement
Agency (DEA) has designated Xywav as a
Schedule III medicine. The DEA defines Schedule III drugs,
substances, or chemicals as drugs with a moderate to low potential
for physical and psychological
dependence.1,2 Because of the risks of central
nervous system (CNS) depression and abuse and
misuse, Xywav is available only through a
restricted program under a Risk Evaluation and Mitigation Strategy
(REMS) called the XYWAV and XYREM REMS.
Important Safety Information for Xywav
WARNING: CENTRAL NERVOUS SYSTEM DEPRESSION and ABUSE
AND MISUSE.
- Central Nervous System Depression
XYWAV is a CNS depressant. Clinically significant respiratory
depression and obtundation may occur in patients treated with XYWAV
at recommended doses. Many patients who received XYWAV during
clinical trials in narcolepsy and idiopathic hypersomnia were
receiving CNS stimulants.
- Abuse and Misuse
The active moiety of XYWAV is oxybate or gamma-hydroxybutyrate
(GHB). Abuse or misuse of illicit GHB, either alone or in
combination with other CNS depressants, is associated with CNS
adverse reactions, including seizure, respiratory depression,
decreases in the level of consciousness, coma, and death.
Because of the risks of CNS depression and abuse and
misuse, XYWAV is available only through a restricted program under
a Risk Evaluation and Mitigation Strategy (REMS) called the XYWAV
and XYREM REMS.
|
Contraindications
XYWAV is contraindicated
- in combination with sedative hypnotics or alcohol and
- in patients
with succinic semialdehyde dehydrogenase deficiency.
Warnings and Precautions
Central Nervous System
Depression
The concurrent use of XYWAV with other CNS depressants,
including but not limited to opioid analgesics, benzodiazepines,
sedating antidepressants or antipsychotics, sedating anti-epileptic
drugs, general anesthetics, muscle relaxants, and/or illicit CNS
depressants, may increase the risk of respiratory depression,
hypotension, profound sedation, syncope, and death. If use of these
CNS depressants in combination with XYWAV is required, dose
reduction or discontinuation of one or more CNS depressants
(including XYWAV) should be considered. In addition, if short-term
use of an opioid (eg, post- or perioperative) is required,
interruption of treatment with XYWAV should be considered.
After first initiating treatment and until certain
that XYWAV does not affect them adversely (eg,
impair judgment, thinking, or motor skills),
caution patients
against hazardous activities requiring
complete mental alertness or
motor coordination such as
operating hazardous machinery,
including automobiles or airplanes. Also caution patients
against these hazardous activities for at least 6 hours after
taking XYWAV. Patients should be queried about CNS
depression-related events upon initiation of
XYWAV therapy and periodically thereafter.
Abuse and Misuse
XYWAV is a Schedule Ill controlled
substance. The active moiety of XYWAV is oxybate, also known
as gamma-hydroxybutyrate (GHB), a Schedule I controlled
substance. Abuse of illicit GHB, either alone or in combination
with other CNS depressants, is associated with CNS adverse
reactions, including seizure, respiratory depression, decreases in
the level of consciousness, coma, and death. The rapid onset of
sedation, coupled with the amnestic features of GHB
particularly when combined with alcohol, has proven to be dangerous
for the voluntary and involuntary user (eg, assault victim).
Physicians should carefully evaluate patients for a history of drug
abuse and follow such patients closely.
XYWAV and XYREM REMS
Because
of the risks of central nervous system depression and abuse and
misuse, XYWAV is available only through a restricted
distribution program called the XYWAV and XYREM REMS.
Notable requirements of the XYWAV and XYREM REMS include
the following:
- Healthcare Providers who
prescribe XYWAV are specially certified
-
XYWAV will be dispensed only by the central pharmacy
that is specially certified
- XYWAV will be dispensed and shipped only to
patients who are enrolled in the XYWAV
and XYREM REMS with documentation of safe use
Further information is
available at www.XYWAVXYREMREMS.com or 1-866-997-3688.
Respiratory Depression and Sleep-Disordered
Breathing
XYWAV may impair respiratory drive, especially in
patients with compromised respiratory function.
In overdoses of oxybate and with
illicit use of GHB, life-threatening respiratory
depression has been reported. Increased apnea and reduced
oxygenation may occur with XYWAV administration in adult
and pediatric patients. A significant increase in
the number of central apneas and clinically
significant oxygen desaturation may occur in
patients with obstructive sleep apnea treated with XYWAV.
Prescribers should be aware that sleep-related breathing disorders
tend to be more prevalent in obese patients, in men, in
postmenopausal women not on hormone replacement therapy, and among
patients with narcolepsy.
Depression and Suicidality
In Study 1, the
randomized-withdrawal clinical trial in adult patients with
narcolepsy (n=201), depression and depressed mood were
reported in 3% and 4%, respectively, of patients treated with
XYWAV. Two patients (1%) discontinued XYWAV
because of depression. In most cases, no change in XYWAV
treatment was required.
In Study 2, the randomized-withdrawal clinical trial in adult
patients with idiopathic hypersomnia (n=154), depression and
depressed mood were reported in 1% and 3%, respectively, of
patients treated with XYWAV. All patients continued XYWAV
treatment.
Two suicides and two attempted suicides occurred in adult
clinical trials with oxybate (same active moiety as XYWAV). One
patient experienced suicidal ideation and two patients reported
depression in a pediatric clinical trial with oxybate. These events
occurred in patients with and without previous histories of
depressive disorders. The emergence of depression in
patients treated with XYWAV requires careful and
immediate evaluation. Monitor patients for the emergence of
increased depressive symptoms and/or
suicidality while taking XYWAV.
Other Behavioral or Psychiatric Adverse
Reactions
In Study 1, confusion and
anxiety occurred in 1% and 5% of patients with
narcolepsy treated with XYWAV, respectively.
One patient experienced visual hallucinations and
confusion after ingesting
approximately 9 grams of XYWAV.
In Study 2, confusion and anxiety occurred in 3% and 16% of
patients with idiopathic hypersomnia, respectively. One
patient experienced visual hallucinations, which led to
discontinuation of XYWAV.
Other neuropsychiatric reactions reported with
oxybate (same active moiety as XYWAV) in adult
or pediatric clinical trials and in the postmarketing
setting include hallucinations, paranoia, psychosis, aggression,
agitation, confusion and anxiety. The emergence or increase in the
occurrence of behavioral or psychiatric events in patients taking
XYWAV should be carefully monitored.
Parasomnias
Parasomnias can occur in patients taking XYWAV.
In Study 1 and Study 2, parasomnias, including
sleepwalking, were reported in 6% and 5% of adult patients treated
with XYWAV, respectively.
In a clinical
trial of XYREM (same active
moiety as XYWAV) in adult patients with narcolepsy, five
instances of sleepwalking with potential injury or significant
injury were reported. Parasomnias, including sleepwalking, have
been reported in a pediatric clinical trial with sodium
oxybate (same active moiety as XYWAV)
and in postmarketing experience with sodium oxybate.
Episodes of sleepwalking should be fully evaluated and appropriate interventions considered.
Most Common Adverse
Reactions
The most common adverse reactions
(occurring in ≥5% of XYWAV-treated patients in adult clinical
trials in either narcolepsy or IH) were nausea,
headache, dizziness, anxiety, insomnia, decreased appetite,
hyperhidrosis, vomiting, diarrhea, dry mouth, parasomnia,
somnolence, fatigue, and tremor.
In the pediatric
clinical trial with XYREM (same active moiety as XYWAV)
that included pediatric patients 7 to 17 years of age with
narcolepsy, the most common adverse reactions (≥5%) were nausea
(20%), enuresis (19%), vomiting (18%), headache (17%), weight
decreased (13%), decreased appetite (9%), dizziness (8%), and
sleepwalking (6%). The overall adverse reaction profile
of XYREM in the pediatric clinical trial was similar to
that seen in the adult clinical trial program. The safety
profile in pediatric patients with XYWAV is expected to
be similar to that of adult patients
treated with XYWAV and to that of pediatric patients treated
with XYREM.
Additional Adverse Reactions
Adverse reactions that
occurred in 2-<5% of adult patients treated with XYWAV in
the Open Label Titration and Stable Dose Periods of the
randomized-withdrawal study in adult patients with narcolepsy with
cataplexy (Study 1) were fatigue, dry mouth, depressed mood,
enuresis, irritability, paresthesia, depression, tremor,
somnolence, and muscle spasms. Adverse reactions occurring in
2-<5% of patients treated with XYWAV in the IH study
include balance disorder, muscle spasms, fall,
paresthesia, snoring, weight decreased, bruxism, confusional
state, depressed mood, feeling drunk, and irritability.
Adverse reactions that occurred in ≥2% of patients in
clinical studies with oxybate (but not
in Study 1) and which may be relevant
for XYWAV, were pain, feeling
drunk, pain in extremity, cataplexy,
disturbance in attention, sleep paralysis, and disorientation.
Discontinuation: In Study 1, 9 of 201 patients (4%) reported
adverse reactions that led to withdrawal from the study (anxiety,
decreased appetite, depressed mood, depression, fatigue, headache,
irritability, nausea, pain in extremity, parasomnia, somnolence,
and vomiting). The most common adverse reaction leading to
discontinuation was nausea (1.5%). In Study 2, 17 of 154 (11%)
patients across all study periods (excluding placebo during the
DB RWP) (up to 42 weeks) reported adverse reactions that
led to withdrawal from the study (anxiety, nausea, insomnia,
vomiting, fatigue, feeling abnormal, fall, decreased appetite,
dizziness, paresthesia, tremor, parasomnia, confusional state,
hallucination visual, and irritability). The most common adverse
reaction leading to discontinuation was anxiety (3.2%). In Study 1
and Study 2, the majority of adverse reactions leading to
discontinuation began during the first few weeks of treatment.
In the pediatric clinical trial with XYREM (same active moiety
as XYWAV), 7 of 104 patients reported adverse reactions that led to
withdrawal from the study (hallucination, tactile; suicidal
ideation; weight decreased; sleep apnea syndrome; affect lability;
anger, anxiety, depression; and headache).
Drug Interactions
XYWAV is contraindicated in
combination with alcohol or sedative hypnotics. Use of other CNS
depressants may potentiate the CNS-depressant effects
of XYWAV.
Concomitant use of sodium oxybate with
divalproex sodium results in an increase in
systemic exposure to GHB, which was shown to cause a
greater impairment on some tests of attention and working memory in
a clinical study. A similar increase in exposure is expected with
concomitant use of XYWAV and divalproex sodium;
therefore, an initial dose reduction of XYWAV is recommended when
used concomitantly with divalproex sodium.
Prescribers are advised to
monitor patient response closely and adjust dose
accordingly if concomitant use of XYWAV and divalproex sodium is warranted.
Pregnancy and Lactation
There are no adequate data on
the developmental risk associated with the use of XYWAV or
sodium oxybate in pregnant women. XYWAV should be used
during pregnancy only if the potential
benefit justifies the potential risk to the fetus. GHB
is excreted in human milk after oral administration of
sodium oxybate. There is
insufficient information on the risk to a breastfed
infant, and there is insufficient information on
milk production in
nursing mothers. The developmental and health benefits
of breastfeeding should be considered along with the
mother's clinical need for XYWAV and any potential adverse effects
on the breastfed infant from
XYWAV or from the underlying
maternal condition.
Pediatric Use
The safety
and effectiveness of XYWAV for the treatment of
cataplexy or excessive daytime sleepiness in pediatric patients 7
years of age and older with narcolepsy have been established.
XYWAV has not been studied in a pediatric clinical trial for
narcolepsy or IH. Use of XYWAV in pediatric patients
7 years of age and older with narcolepsy is supported by evidence
from an adequate
and wellcontrolled study of sodium oxybate
in pediatric patients 7 to 17 years of age, a study in adults
showing a treatment effect of XYWAV
similar to that observed with sodium oxybate, pharmacokinetic
data of sodium oxybate from adult and pediatric patients, and
pharmacokinetic data of
XYWAV from healthy adult volunteers.
Safety and effectiveness of XYWAV in pediatric patients
below the age of 7 years with
narcolepsy have not been established.
Safety and effectiveness of XYWAV for the treatment of
idiopathic hypersomnia in pediatric patients have not been
established.
Geriatric Use
In general, dose selection for an
elderly patient should be cautious, usually starting at the low end
of the dosing range, reflecting the greater frequency of
decreased hepatic, renal, or cardiac function, and
of concomitant disease
or other drug therapy.
Hepatic
Impairment
The starting dose of XYWAV should be reduced in patients with liver impairment.
Dosage Modification in Patients with Hepatic
Impairment: The recommended starting dosage in patients
with hepatic impairment is one-half of the original dosage per
night, administered orally, divided into two doses.
Dependence and
Tolerance
There have been case reports of withdrawal, ranging from mild to severe, following discontinuation of illicit
use of GHB at
frequent repeated doses (18 g to 250 g per
day) in excess of the recommended dosage range.
Signs and symptoms of GHB withdrawal following abrupt
discontinuation included insomnia, restlessness, anxiety,
psychosis, lethargy, nausea, tremor, sweating, muscle cramps,
tachycardia, headache, dizziness, rebound fatigue and sleepiness,
confusion, and, particularly in the case of severe withdrawal,
visual hallucinations, agitation, and delirium. These symptoms
generally abated in 3 to 14 days. In cases of severe withdrawal,
hospitalization may be required.
In the clinical trial experience with XYREM in
narcolepsy/cataplexy patients at recommended doses, two patients
reported anxiety and one reported insomnia following abrupt
discontinuation at the termination of the clinical trial; in the
two patients with anxiety, the frequency of cataplexy had increased
markedly at the same time. In the XYWAV clinical trial in
adult narcolepsy/cataplexy patients at recommended doses, one
patient reported
insomnia following abrupt discontinuation of XYWAV.
In the XYWAV clinical trial in adult idiopathic hypersomnia
patients at recommended doses, six patients reported insomnia, two
patients reported early insomnia, and one patient reported visual
and auditory hallucinations following abrupt discontinuation of
XYWAV.
Tolerance to XYWAV has not been systematically studied in
controlled clinical trials. There have been some case reports
of symptoms of tolerance developing after illicit use at dosages
far in excess of
the recommended XYWAV dosage regimen.
Important Safety Information for Xyrem
WARNING: CENTRAL
NERVOUS SYSTEM DEPRESSION and ABUSE AND MISUSE.
- Central Nervous System Depression
XYREM is a Central Nervous System (CNS) depressant. In clinical
trials at recommended doses, obtundation and clinically significant
respiratory depression occurred in adult patients treated with
XYREM. Many patients who received XYREM during clinical trials in
narcolepsy were receiving CNS stimulants.
- Abuse and Misuse
XYREM is the sodium salt of gamma hydroxybutyrate (GHB). Abuse
or misuse of illicit GHB, either alone or in combination with other
CNS depressants, is associated with CNS adverse reactions,
including seizure, respiratory depression, decreases in the level
of consciousness, coma, and death.
Because of the risks
of CNS depression and abuse and misuse, XYREM is available only
through a restricted program under a Risk Evaluation and Mitigation
Strategy (REMS) called the XYWAV and XYREM REMS.
|
Contraindications
XYREM is contraindicated
for use in combination with sedative
hypnotics or alcohol and in patients
with succinic semialdehyde dehydrogenase deficiency.
Warnings and Precautions
CNS Depression: Use caution
when considering the concurrent use of Xyrem with other CNS
depressants. If concurrent use is required, consider dose reduction
or discontinuation of one or more CNS depressants
(including XYREM). Consider interrupting
XYREM treatment if short-term opioid use is
required. After first initiating treatment and until certain that
XYREM does not affect them adversely, caution patients against
hazardous activities requiring complete mental alertness or motor
coordination such as operating hazardous machinery, including
automobiles or airplanes. Also caution patients against these
hazardous activities for at least 6 hours after taking XYREM.
Patients should be queried
about CNS depression-related events
upon initiation of XYREM therapy
and periodically thereafter.
- Abuse and Misuse: XYREM is a Schedule III controlled
substance. The rapid onset of sedation, coupled with the amnestic
features of XYREM, particularly when combined with alcohol,
has proven to be dangerous for the voluntary and involuntary user
(eg, assault victim).
- Respiratory Depression and Sleep-Disordered Breathing: XYREM
may impair respiratory drive, especially in patients with
compromised respiratory function. In overdoses, life-threatening
respiratory depression has been reported. Prescribers should be
aware that increased central apneas and clinically
relevant desaturation events have been observed
with XYREM administration in adult and pediatric patients.
Sleep-related breathing disorders tend to be more prevalent in
obese patients, in men, in postmenopausal women not on hormone
replacement therapy and among patients with narcolepsy.
- Depression and Suicidality: In adult clinical trials in
patients with narcolepsy (n=781), depression was reported by 7% of
XYREM-treated patients, with four patients (<1%) discontinuing
because of depression. In the pediatric clinical trial in patients
with narcolepsy (n=104), one patient experienced suicidal ideation
and two patients reported depression while taking XYREM. Monitor
patients for emergent or increased depression and/or
suicidality, which require
careful and immediate evaluation.
- Other Behavioral or Psychiatric Adverse Reactions: Monitor
patients for impaired motor/cognitive function or the emergence of
or increase in anxiety and/or confusion. The emergence or increase
in the occurrence of behavioral or psychiatric events in adult and
pediatric patients taking XYREM should be carefully
monitored.
- Parasomnias: Episodes of sleepwalking should be fully evaluated
and appropriate interventions considered. Five instances of
significant injury or potential injury were associated with
sleepwalking during a clinical trial of
XYREM in adult patients
with narcolepsy. Parasomnias, including sleepwalking,
also have been reported in the pediatric clinical trial and in
postmarketing experience with XYREM.
- Patients Sensitive to High Sodium Intake: XYREM has a high
salt content. In patients sensitive to salt intake (eg, those with
heart failure, hypertension, or renal impairment), consider the
amount of daily sodium intake in each dose of XYREM.
Most Common Adverse Reactions
In three controlled
adult clinical trials in patients with narcolepsy, the most common
adverse reactions (incidence ≥5% and twice the rate of placebo)
in XYREM-treated patients were nausea, dizziness, vomiting,
somnolence, enuresis, and tremor. In the pediatric clinical trial
in patients 7 years of age and older with narcolepsy, the most
common adverse reactions (≥5%) were nausea (20%), enuresis (19%),
vomiting (18%), headache (17%), weight decreased (13%), decreased
appetite (9%), dizziness (8%) and sleepwalking (6%).
About Jazz Pharmaceuticals
Jazz Pharmaceuticals plc is
a global biopharma company whose purpose is to innovate to
transform the lives of patients and their families. We are
dedicated to developing potentially life-changing medicines for
people with serious diseases — often with limited or no therapeutic
options. We have a diverse portfolio of marketed medicines,
including leading therapies for sleep disorders and epilepsy, and a
growing portfolio of cancer treatments. Our patient-focused and
science-driven approach powers pioneering research and development
advancements across our robust pipeline of innovative therapeutics
in oncology and neuroscience. Jazz is headquartered in Dublin,
Ireland with research and development laboratories,
manufacturing facilities and employees in multiple countries
committed to serving patients worldwide. Please visit
www.jazzpharmaceuticals.com for more information.
Contacts:
Media:
Kristin Bhavnani
Head of Global Corporate Communications
Jazz Pharmaceuticals plc
CorporateAffairsMediaInfo@jazzpharma.com
Ireland +353 1 637 2141
U.S. +1 215 867 4948
Investors:
Andrea N. Flynn, Ph.D.
Vice President, Head, Investor Relations
Jazz Pharmaceuticals plc
InvestorInfo@jazzpharma.com
Ireland +353 1 634 3211
U.S. +1 650 496 2717
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Accessed October 2024.
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cataplexy. Lancet. 2007;369(9560):499-511.
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Sleep Medicine and Research, eds. Sleep Disorders and Sleep
Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press
(US); 2006.
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co-morbidities & treatment. Indian Journal of Medical
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2019. https://www.nhs.uk/conditions/narcolepsy/.
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burden of narcolepsy disease (CV-BOND): a real-world evidence
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2020.
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idiopathic hypersomnia. Expert Opin Investig Drugs.
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patients with narcolepsy with cataplexy, narcolepsy without
cataplexy, and idiopathic hypersomnia without long sleep time:
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