ベンゾジアゼピン系薬の長期使用患者におけるレンボレキサントの導入方法に関する検討

抄録

Short-term use of hypnotics is recommended for the pharmacological management of insomnia due to safety concerns. Long-term use of benzodiazepines (BZDs) is associated with increased risks of falls, dependence, and withdrawal symptoms; however, it remains common in clinical practice. Lemborexant (LEM), an orexin receptor antagonist, is considered a safer alternative to BZDs because of its lower risk of falls and dependence. Clinical trials and meta-analyses have demonstrated that LEM is safe and well tolerated and effective for both sleep onset and maintenance. However, the impact of different methods for introducing LEM in patients with long-term BZD use has not yet been fully clarified. This study aimed to elucidate the optimal method for introducing LEM in these patients. We retrospectively analyzed 51 inpatients with long-term use of BZDs (≧4 weeks) who were prescribed LEM between September 1, 2020, and August 31, 2023. Patients were divided into an add-on group (n = 18) and a switching group (n = 33). The continuation rate of LEM therapy was 94.4％ and 75.8％ in the add-on and switching groups, respectively, with no significant difference between the two. Among patients who continued LEM, complete BZD discontinuation was achieved in 64.0％ and 17.6％ of the switching and add-on groups, respectively (P = 0.004). This study demonstrated that different strategies for introducing LEM did not affect the continuation rates among patients with long-term BZD use. However, switching may facilitate more rapid BZD discontinuation than the add-on approach.