{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:50:15Z","timestamp":1791366615746,"version":"4.3.1"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"07","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":43,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Insomnia is a prevalent disorder associated with impaired daytime functioning and reduced quality of life. Dual orexin receptor antagonists (DORAs) have shown favorable short-term efficacy and safety profiles. However, evidence regarding their long-term (\u2265 6 months) effects remains limited.<\/jats:p>\n                  <jats:p>To synthesize the available evidence on prolonged DORA use in adults with chronic insomnia.<\/jats:p>\n                  <jats:p>We conducted a systematic review and meta-analysis of randomized controlled trial. Adults with primary insomnia treated with DORAs (suvorexant, lemborexant, or daridorexant) approved by the United States Food and Drug Administration (FDA) for \u2265 6 months were included. The outcomes included patient-reported sleep parameters, adverse events, and treatment discontinuation.<\/jats:p>\n                  <jats:p>We included 6 randomized controlled trials comprising 3,546 participants. After 6 and 12 months, DORAs improved subjective sleep parameters of efficacy. Overall, DORAs showed adverse events similar to those of placebo at 6 months, but higher rates at 12 months. The overall rate of discontinuation due to adverse events did not differ significantly, although higher doses of certain DORAs increased the discontinuation rate at 6 months.<\/jats:p>\n                  <jats:p>In chronic insomnia, DORAs provide sustained improvements in key subjective sleep outcomes, with overall acceptable safety and tolerability profiles. Higher doses may be less well tolerated. Additional long-term randomized trials are needed to better define the efficacy and safety of DORAs in clinical practice.<\/jats:p>","DOI":"10.1055\/s-0046-1827049","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:16:11Z","timestamp":1786662971000},"page":"001-010","source":"Crossref","is-referenced-by-count":0,"title":["Long-term use of dual orexin receptor antagonists for the treatment of insomnia: a systematic review and meta-analysis"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4894-8537","authenticated-orcid":false,"given":"Luis Miguel Moraes","family":"Araujo","sequence":"additional","affiliation":[{"name":"Coordena\u00e7\u00e3o do Curso de Medicina, Universidade Federal do Maranh\u00e3o, S\u00e3o Luis MA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8112-6032","authenticated-orcid":false,"given":"Arthur Duarte de","family":"Sousa","sequence":"additional","affiliation":[{"name":"Coordena\u00e7\u00e3o do Curso de Medicina, Universidade Federal do Maranh\u00e3o, S\u00e3o Luis MA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7881-463X","authenticated-orcid":false,"given":"Camila de Carvalho","family":"Vieira","sequence":"additional","affiliation":[{"name":"Coordena\u00e7\u00e3o do Curso de Medicina, Universidade Federal do Maranh\u00e3o, S\u00e3o Luis MA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9495-1367","authenticated-orcid":false,"given":"Jo\u00e3o Pedro Pimentel","family":"Abreu","sequence":"additional","affiliation":[{"name":"Coordena\u00e7\u00e3o do Curso de Medicina, Universidade Federal do Maranh\u00e3o, S\u00e3o Luis MA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2758-4830","authenticated-orcid":false,"given":"Cristiane Fiquene","family":"Conti","sequence":"additional","affiliation":[{"name":"Coordena\u00e7\u00e3o Especial de Morfologia (CEMOR), Universidade Federal do Maranh\u00e3o, S\u00e3o Luis MA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4773-1612","authenticated-orcid":false,"given":"Melaine Mont'Alverne Lawall","family":"Silva","sequence":"additional","affiliation":[{"name":"Coordena\u00e7\u00e3o Especial de Morfologia (CEMOR), Universidade Federal do Maranh\u00e3o, S\u00e3o Luis MA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8768-5297","authenticated-orcid":false,"given":"Marcio Moyses de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Coordena\u00e7\u00e3o Especial de Morfologia (CEMOR), Universidade Federal do Maranh\u00e3o, S\u00e3o Luis MA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"publisher","first-page":"e14035","DOI":"10.1111\/jsr.14035","article-title":"The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023","volume":"32","author":"D Riemann","year":"2023","journal-title":"J Sleep Res"},{"issue":"04","key":"ref2","doi-asserted-by":"publisher","first-page":"S76","DOI":"10.37765\/ajmc.2020.42769","article-title":"Insomnia overview: epidemiology, pathophysiology, diagnosis and monitoring, and nonpharmacologic therapy","volume":"26","author":"J A Dopheide","year":"2020","journal-title":"Am J Manag Care"},{"issue":"01","key":"ref3","first-page":"44","article-title":"Insomnia: a current review","volume":"121","author":"S Naha","year":"2024","journal-title":"Mo 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Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0046-1827049.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:56:59Z","timestamp":1791363419000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0046-1827049"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":37,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2026,5,12]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["s00461827049"],"URL":"https:\/\/doi.org\/10.1055\/s-0046-1827049","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"value":"0004-282X","type":"print"},{"value":"1678-4227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}