NICE has published draft guidance recommending a new drug for GPs to prescribe to patients with long-term insomnia.
Today’s new guidance said that daridorexant, produced by the company Idorsia, should be used to treat adults if they have tried cognitive behavioural therapy for insomnia (CBTi) and it has not worked, or if this therapy is not available.
Daridorexant is a pill that is taken half an hour before going to sleep every night, and clinical trial evidence has shown that it improved insomnia symptoms compared with a placebo over a 12-month period.
Its effectiveness was shown by a reduction in the total number of minutes that a person is awake after initially falling asleep as well as the time it takes to fall asleep after going to bed.
The drug works by blocking the action of two types of orexins, the chemicals that help the body stay awake.
The length of treatment should be ‘as short as possible’, stressed NICE, with GPs to assess patients within three months of starting the drug.
The independent appraisal committee noted that daridorexant is new to GPs, as the ‘first medicine available’ for longer-term treatment of long-term insomnia.
‘The clinical experts highlighted that, if daridorexant were recommended, support and training of GPs would be key for its implementation because people’s experience of the condition is subjective,’ the draft guidance said.
The committee also emphasised that GPs should always offer CBTi before daridorexant, but accepted that access to this service is not consistent across the country.
One clinical expert argued that GPs ‘should be encouraged to explore reasons why CBTi is not available’.
However, the committee said ICBs should be responsible for ensuring CBTi is available in their area, given GPs are under capacity pressures and may not have time to address the lack of services.
NICE estimated that just over 20,000 people in England could be prescribed the drug in the first year.
GPs are advised to diagnose insomnia in adults who have symptoms lasting for at least three nights per week for at least three months, and whose daytime functioning is considerably affected.