SOLRIAMFETOL TITRATION AND ADMINISTRATION: PHYSICIAN TITRATION STRATEGIES IN A HYPOTHETICAL PATIENT WITH OSA

TOPIC: Sleep Disorders TYPE: Original Investigations PURPOSE: Solriamfetol (Sunosi®) is a dopamine/norepinephrine reuptake inhibitor approved (US and EU) to treat excessive daytime sleepiness (EDS) in adults with narcolepsy (75-150 mg/d) or obstructive sleep apnea (OSA) (37.5-150 mg/d). Titration strategies for hypothetical patient were analyzed understand factors physicians consider when initiating solriamfetol. METHODS: This virtual, descriptive, cross-sectional, qualitative survey of solriamfetol titration administration (START) enrolled US-based treating patients EDS due OSA/narcolepsy. Responses 4 open-ended questions on recorded. Patient scenario: 48-year-old man OSA, obesity (BMI=35), hypercholesterolemia who uses continuous positive airway pressure ≥6 hours/night has taken modafinil (400 2 years which no longer controls his (Epworth Sleepiness Scale [ESS]=13). Content analysis recordings identified themes responses; trained linguist captured language patterns. RESULTS: Twenty-six (7 neurologists; 7 internists; 6 pulmonologists; 5 psychiatrists; 1 otolaryngologist) OSA 16.3±6.5 representing 781 stable participated; 73% board-certified medicine. All thought the would be appropriate solriamfetol, citing lack symptom control (65%), high dose (31%), ESS level (27%). To start most suggested switching from (21 [81%]); (15%) add (4%) felt it depended other factors. Fourteen (54%) not titrate per label, whom 86% at 75 mg. Ten (39%) discontinue abruptly; others taper while (5 [19%]) before starting [19%]), (4 [15%]), use another approach (2 [8%]). Current (23%), likelihood adverse reaction (15%), similar mechanism action (12%), severity (4%), (12%) influenced physicians' decisions; 42% cited influencing their decision. If was taking modafinil, 11 (42%) label 37.5 mg; 15 (58%) alternative approaches. Controlled hypertension change (81%) CONCLUSIONS: Most as rationale recommending this scenario. considered specific titrating (most commonly prior medication). controlled hypertension. CLINICAL IMPLICATIONS: Response medication by OSA. DISCLOSURES: Consultant relationship Jazz Pharmaceuticals Please note: 6/2020-8/2020 Added 04/07/2021 Elizabeth Baldys, source=Web Response, value=Consulting fee Employee 11/2019 till now 04/30/2021 Abby Chen, value=Salary 2014 - current 04/13/2021 Danielle Hyman, Stock Holder value=Ownership interest Stratevi Aug 2018 Apr 2021 04/01/2021 Diane Ito, 4/2019-Present Gregory Parks, Removed 04/26/2021 value=stock options No relevant relationships Haramandeep Singh, Advisory Committee Member 3000 Michael Thorpy,