482 Solriamfetol Titration & AdministRaTion (START): dosing and titration strategies in patients with narcolepsy starting solriamfetol

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A190-A190
Author(s):  
Michael Thorpy ◽  
Danielle Hyman ◽  
Gregory Parks ◽  
Abby Chen ◽  
Catherine Foley ◽  
...  
Keyword(s):  
Real World ◽  
Chart Review ◽  
De Novo ◽  
Descriptive Study ◽  
Final Dose ◽  
Stable Dose ◽  
Obstructive Sleep ◽  
Norepinephrine Reuptake Inhibitor

Abstract Introduction Solriamfetol (Sunosi®), a dopamine/norepinephrine reuptake inhibitor, is approved (US and EU) to treat excessive daytime sleepiness (EDS) in adults with narcolepsy (75–150 mg/day) or obstructive sleep apnea (OSA) (37.5–150 mg/day). Previous research examined the use of solriamfetol in clinical trial settings but research in real-world settings was not previously conducted. This study characterized real-world dosing and titration with solriamfetol. Methods This virtual, descriptive study included a quantitative retrospective patient chart review among US-based physicians prescribing solriamfetol. Target enrollment was 25 physicians treating patients with EDS associated with OSA or narcolepsy. Titration strategies were classified as de novo (no prior EDS medication), transition (switched/switching from existing EDS medications onto solriamfetol), or add-on (adding solriamfetol to current EDS medication). Results Twenty-six physicians participated. Seventy patients with narcolepsy were analyzed (type 1, n=24; type 2, n=46; mean±SD age, 40±11 years; 57% female; 6 also had OSA); EDS was primarily moderate (59%) or severe (36%). Solriamfetol initiation was de novo for 19 (27%) patients, transition for 31 (44%), and add-on for 20 (29%). Most patients (86%) started solriamfetol at 75 mg; 11% and 3% started at 37.5 mg and 150 mg, respectively. The final/stable dose was 150 mg for 76% (53/70) of patients and 75 mg for 24% (17/70). Most patients (67%) had 1 dose adjustment to reach their final dose; 4% had 2 adjustments, 4% had 3 adjustments, and 24% had none. Mean±SD time to reach a stable dose was 15.1±11.8 days overall, 19.4±9.3 days with de novo treatment, 15.0±13.7 days for transition, and 11.9±8.6 days for add-on. Physicians most frequently considered EDS severity (44% of patients) when titrating. Among patients transitioning, 14/22 (64%) taking a wake-promoting agent (WPA) discontinued it abruptly while 5/9 (56%) taking a stimulant were tapered off. Physicians were overall likely (n=33, 47%) or very likely (n=30, 43%) to recommend their approach for similar patients. Conclusion In a real-world study, the majority of physicians prescribing solriamfetol for patients with narcolepsy started at the 75-mg dose, tapered stimulants but abruptly discontinued WPAs, and made 1 adjustment to reach a stable dose across 15 days on average. Support (if any) Jazz Pharmaceuticals

scholarly journals P148 Solriamfetol Titration & AdministRaTion (START): Dosing and titration strategies in patients with narcolepsy starting solriamfetol

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A69-A70
Author(s):  
M Thorpy ◽  
D Hyman ◽  
G Parks ◽  
A Chen ◽  
C Foley ◽  
...  
Keyword(s):  
Real World ◽  
Dose Adjustment ◽  
Chart Review ◽  
De Novo ◽  
Sleep Apnoea ◽  
Patient Chart ◽  
Obstructive Sleep ◽  
Norepinephrine Reuptake Inhibitor

Abstract Introduction Solriamfetol (Sunosi) is a dopamine/norepinephrine reuptake inhibitor approved (EU/US) to treat excessive daytime sleepiness (EDS) in adults with narcolepsy (75–150 mg/day) or obstructive sleep apnoea (OSA) (37.5–150 mg/day). This study characterised real-world dosing and titration with solriamfetol in patients with narcolepsy. Methods A retrospective patient chart review was conducted among US-based physicians prescribing solriamfetol. Initiation strategies were de novo (no prior EDS medication), transition (switched/switching from existing EDS medications to solriamfetol), or add-on (adding solriamfetol to current EDS medication). Results Twenty-three physicians entered data from 70 patients with narcolepsy (type 1, 24/70; type 2, 46/70; mean+/-SD age, 40+/-11 years; 57% female; 6 also had OSA). EDS was mainly moderate (59%) or severe (36%). Nineteen patients (27%) initiated de novo, 31 (44%) transitioned, and 20 (29%) were add-on. Most patients started solriamfetol at 75 mg (86%) and were stable at 150 mg (76%). Most (67%) had 1 dose adjustment; median (range) time to a stable dose was 14 (1–60) days. EDS severity (44% of patients) was frequently considered when titrating. Fourteen of 22 (64%) transitioning from wake-promoting agents (WPAs) stopped them abruptly; 5/9 (56%) using stimulants tapered off. Discussion In a real-world study, most physicians prescribing solriamfetol to patients with narcolepsy started at 75 mg, tapered stimulants, abruptly discontinued WPAs, and made 1 dose adjustment. Support Jazz Pharmaceuticals

481 Solriamfetol Titration & AdministRaTion (START): Characteristics of patients with narcolepsy and solriamfetol prescriber rationale

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A190-A190
Author(s):  
Michael Thorpy ◽  
Danielle Hyman ◽  
Gregory Parks ◽  
Abby Chen ◽  
Catherine Foley ◽  
...  
Keyword(s):  
Side Effects ◽  
Chart Review ◽  
De Novo ◽  
Primary Reason ◽  
Migraine Headaches ◽  
Obstructive Sleep ◽  
Norepinephrine Reuptake Inhibitor ◽  
Efficacy Profile

Abstract Introduction Pharmacotherapy for excessive daytime sleepiness (EDS) associated with narcolepsy is diverse, with factors such as efficacy, side effects, and tolerance influencing treatment decisions. Solriamfetol (Sunosi®), a dopamine/norepinephrine reuptake inhibitor, is approved (US and EU) to treat EDS in adults with narcolepsy (75–150 mg/day) or obstructive sleep apnea (OSA) (37.5–150 mg/day). This study characterized real-world patients with narcolepsy starting solriamfetol and prescribers’ rationales for initiating treatment. Methods This virtual, descriptive study included a quantitative retrospective patient chart review among US-based physicians prescribing solriamfetol. Target enrollment was 25 physicians treating patients with EDS associated with OSA or narcolepsy. Treatment initiation was classified as de novo (no EDS medication prior to solriamfetol), transition (switched/switching from existing EDS medications onto solriamfetol), or add-on (adding solriamfetol to current EDS medication). Results Twenty-six physicians participated. Seventy patients with narcolepsy were analyzed (type 1, n=24; type 2, n=46; mean±SD age, 40±11 years; 57% female; 6 also had OSA); EDS was primarily moderate (59%) or severe (36%). Twenty-two patients (31%) were obese (BMI≥30); other common physician-reported comorbidities were migraine headaches (n=12, 17%), depression (n=10, 14%), and cardiovascular disorders (n=10, 14%). Solriamfetol initiation was de novo for 19 (27%) patients, transition for 31 (44%), and add-on for 20 (29%). Patients transitioning to solriamfetol were taking 1 (29/31, 94%) or 2 (2/31, 7%) prior EDS medications; patients adding solriamfetol were taking 1 (16/20, 80%), 2 (3/20, 15%) or 3 (1/20, 5%). Most patients transitioning to solriamfetol were taking wake-promoting agents (22/31, 71%); patients adding solriamfetol were most frequently taking sodium oxybate (11/20, 55%). Solriamfetol’s efficacy profile was the primary reason prompting the discussion to prescribe solriamfetol de novo (12/19, 63%); need for better efficacy/augmenting effects of other medications was the primary reason for transitioning (18/31, 58%) and add-on therapy (19/20, 95%). At data collection, 63 (90%) patients were still on a stable solriamfetol dose. The most common reasons for discontinuing solriamfetol were lack of efficacy (n=3) and side effects (n=3). Conclusion Efficacy and the need for improved efficacy over existing medication(s) were key considerations for physicians prescribing solriamfetol treatment to patients with narcolepsy in clinical practice. Support (if any) Jazz Pharmaceuticals

scholarly journals P147 Solriamfetol Titration & AdministRaTion (START): Characteristics of patients with obstructive sleep apnoea (OSA) and prescriber rationale for starting treatment with solriamfetol

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A69-A69
Author(s):  
H Singh ◽  
D Hyman ◽  
G Parks ◽  
A Chen ◽  
C Foley ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Chart Review ◽  
Positive Airway Pressure ◽  
De Novo ◽  
Descriptive Study ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Nonpharmacologic Treatment ◽  
Norepinephrine Reuptake Inhibitor

Abstract Introduction Solriamfetol (Sunosi) is a dopamine/norepinephrine reuptake inhibitor approved (EU/US) to treat excessive daytime sleepiness (EDS) in adults with OSA (37.5–150 mg/day) or narcolepsy (75–150 mg/day). This study examined characteristics of patients with OSA initiating solriamfetol and prescribers’ rationales. Methods This descriptive study included a retrospective patient chart review among US-based physicians prescribing solriamfetol for patients with OSA/narcolepsy. Solriamfetol initiation strategies were classified as de novo (no prior EDS medication), transition (switched/switching from existing EDS medications), or add-on (adding to current EDS medication). Results Physicians (n=24) entered data from 50 patients with OSA (mean+/-SD age, 52+/-9.1 years; 62% male). EDS was primarily moderate (56%) or severe (36%). Mean+/-SD Apnea-Hypopnoea Index at OSA diagnosis was 33.1+/-19.7 (n=37). The most common nonpharmacologic treatment was positive airway pressure (n=39, 78%); 36/39 (92%) were considered adherent. Common comorbidities included obesity (BMI>/=30) (n=25, 50%), cardiovascular disorders (n=16, 32%), and type 2 diabetes (n=14, 28%). Twenty-two (44%) patients were de novo, 26 (52%) transitioned (primarily from wake-promoting agents [18/26, 69%]), and 2 (4%) added solriamfetol (to stimulants). The efficacy of solriamfetol prompted most discussions to prescribe de novo (18/22, 82%); a desire for improved efficacy and/or augmentation of other medications prompted most transitioning (15/26, 58%) and add-on (2/2, 100%) therapy. At data collection, 48 (96%) patients were stable on solriamfetol; one each discontinued due to lack of efficacy and side effects. Discussion Efficacy was a key consideration for physicians prescribing solriamfetol for EDS in a real-world sample of patients with OSA. Support Jazz Pharmaceuticals

126-LB: Glycemic Outcomes for People with Type 1 and Type 2 Diabetes Using Control-IQ Technology: Real-World Data from Early Adopters

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 126-LB ◽  
Author(s):  
STEPHANIE HABIF ◽  
ALEXANDRA CONSTANTIN ◽  
LARS MUELLER ◽  
HARSIMRAN SINGH
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Real World Data ◽  
Early Adopters ◽  
World Data ◽  
Glycemic Outcomes

scholarly journals CNNM2-Related Disorders: Phenotype and Its Severity Were Associated With the Mode of Inheritance

2021 ◽  
Vol 9 ◽  
Author(s):  
Han Zhang ◽  
Ye Wu ◽  
Yuwu Jiang
Keyword(s):  
De Novo ◽  
Serum Magnesium ◽  
Brain Magnetic Resonance Imaging ◽  
Functional Studies ◽  
Pathogenic Variants ◽  
Significant Difference ◽  
Domain Variations ◽  
Type 3

CNNM2 (Cystathionine-β-synthase-pair Domain Divalent Metal Cation Transport Mediator 2) pathogenic variants have been reported to cause hypomagnesemia, epilepsy, and intellectual disability/developmental delay (ID/DD). We identified two new cases with CNNM2 novel de novo pathogenic variants, c.814T>C and c.976G>C. They both presented with infantile-onset epilepsy with DD and hypomagnesemia refractory to magnesium supplementation. To date, 21 cases with CNNM2-related disorders have been reported. We combined all 23 cases to analyze the features of CNNM2-related disorders. The phenotypes can be classified into three types: type 1, autosomal dominant (AD) inherited simple hypomagnesemia; type 2, AD inherited hypomagnesemia with epilepsy and ID/DD; and type 3, autosomal recessive (AR) inherited hypomagnesemia with epilepsy and ID/DD. All five type 1 cases had no epilepsy or ID/DD; they all had hypomagnesemia, and three of them presented with symptoms secondary to hypomagnesemia. Fifteen type 2 patients could have ID/DD and seizures, which can be controlled with antiseizure medications (ASMs); their variations clustered in the DUF21 domain of CNNM2. All three type 3 patients had seizures from 1 to 6 days after birth; the seizures were refractory, and 1/3 had status epilepticus; ID/DD in these AR-inherited cases was more severe than that of AD-inherited cases; they all had abnormalities of brain magnetic resonance imaging (MRI). Except for one patient whose serum magnesium was the lower limit of normal, others had definite hypomagnesemia. Hypomagnesemia could be improved after magnesium supplement but could not return to the normal level. Variations in the CBS2 domain may be related to lower serum magnesium. However, there was no significant difference in the level of serum magnesium among the patients with three different types of CNNM2-related disorders. The severity of different phenotypes was therefore not explained by decreased serum magnesium. We expanded the spectrum of CNNM2 variants and classified the phenotypes of CNNM2-related disorders into three types. We found that DUF21 domain variations were most associated with CNNM2-related central nervous system phenotypes, whereas hypomagnesemia was more pronounced in patients with CBS2 domain variations, and AR-inherited CNNM2-related disorders had the most severe phenotype. These results provide important clues for further functional studies of CNNM2 and provide basic foundations for more accurate genetic counseling.

64-LB: Glucose Control after Initiation of Flash Glucose Monitoring in Type 2 Diabetes Managed with Basal Insulin: A Retrospective Real-World Chart Review Study from the U.S.

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 64-LB
Author(s):  
ANDERS L. CARLSON ◽  
TIMOTHY D. DANIEL ◽  
ANDREA DESANTIS ◽  
SERGE JABBOUR ◽  
ESRA KARSLIOGLU-FRENCH ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Glucose Control ◽  
Basal Insulin ◽  
Chart Review ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Review Study ◽  
The U.S

710-P: Real-World Evaluation of Glycemic Outcomes by Prior Therapy for People with Type 1 and Type 2 Diabetes Onboarding to Control-IQ Technology

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 710-P
Author(s):  
JOHN W. MORBERG ◽  
HARSIMRAN SINGH ◽  
MOLLY MCELWEE-MALLOY ◽  
STEPHANIE HABIF ◽  
ALEXANDRA CONSTANTIN
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Prior Therapy ◽  
Glycemic Outcomes

Of ants and academics: The computational power of external representation

1997 ◽  
Vol 20 (1) ◽  
pp. 78-79
Author(s):  
Jon Oberlander
Keyword(s):  
Real World ◽  
External Representation ◽  
External Representations ◽  
Computational Power ◽  
The Real

Clark & Thornton speculate that intervening in the real world might be a way of transforming type-2 problems into type-1, but they state that they are not aware of any definite cases. It is argued that the active construction of external representations often performs exactly this function, and that recoding via the real world is therefore common, if not ubiquitous.

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