Improving the Understanding of Narcolepsy and its Pathophysiology: Richard Bogan, MD, FCCP, FAASM

WATCH TIME: 2 minutes

"Excessive sleepiness effects executive function, motivation, and productivity. We worry about workplace and driving fatigue-related accidents and the social interaction—all of those functional outcomes. We’re beginning to recognize it more."

Although there is no cure for narcolepsy, there are several medications and lifestyle modifications that can help manage the symptoms. Therapeutics such as solriamfetol (Sunosi; Axsome Therapeutics) and pitolisant (Wakix; Harmony Biosciences) are newer stimulants used for narcolepsy, headache, and anxiety. Similarly, selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors have been typically prescribed to suppress REM sleep. Sodium oxybate has been the most traditional and effective medication for these patients, improving both nighttime sleep as well as helping control excessive daytime sleepiness (EDS).

In 2020, the FDA approved JZP-258 (Xywav; Jazz Pharmaceuticals), a combination of calcium, magnesium, potassium, and sodium oxybates, for the treatment of cataplexy or EDS in patients 7 years of age or older with narcolepsy. In addition to expanding the treatment options, this oxybate product contains a unique composition of cations resulting in 92% less sodium, or approximately 1000 to 1500 mg/night, than sodium oxybate (Xyrem; Jazz), the only approved agent for this indication at the time.

Richard Bogan, MD, FCCP, FAASM, associate professor, University of South Carolina School of Medicine, associate clinical professor, Medical University of South Carolina, and lead investigator of the phase 3 study that led to JZP-258’s approval, believes there is still much work to be done in the care for patients with narcolepsy. At the 2022 SLEEP Annual Meeting, June 4-8, in Charlotte, North Carolina, Bogan discussed the progress made in the field, along with the challenges that remain. He stressed the need to not only help symptoms associated with the disease but improve functional outcomes that will translate to better quality of life.

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