Lemborexant for Shift Work Sleep Disorder

Recruiting at 1 trial location

Overseen By Alex Desautels, M.D., Ph.D.

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal

Must not be taking: Hypnotics, Neuroleptics, Antidepressants, others

Disqualifiers: Sleep disorders, Epilepsy, Psychiatric disorders, others

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 4 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 4

Duration: 4 days per visit, with a 2-week washout period between visits

24 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether lemborexant can help people recover better sleep during the day after working night shifts. The aim is to determine if the drug can improve sleep without causing daytime sleepiness. Participants will receive either lemborexant or a placebo (a pill without active medication) while researchers monitor their sleep and alertness. Individuals who have not done shift work in the past year and typically go to bed between 9 p.m. and midnight might be suitable for this study. As a Phase 2 trial, this research measures how well lemborexant works in an initial, smaller group, offering participants a chance to contribute to important sleep research.

Will I have to stop taking my current medications?

The trial requires participants to stop using certain medications, especially those affecting sleep or wakefulness, like hypnotics, stimulants, and some antidepressants, at least one week before screening. If you're taking medications that are moderate or strong CYP3A4 inhibitors or inducers, you may also need to stop those. It's best to discuss your specific medications with the trial team.

Is there any evidence suggesting that lemborexant is likely to be safe for humans?

Research has shown that lemborexant is generally well-tolerated. In a study on its use for insomnia, some participants felt very sleepy and experienced potential next-day drowsiness, which are the main safety concerns. However, the FDA has approved lemborexant for treating insomnia, indicating it is considered safe for this use.

Early results from other studies on shift work suggest lemborexant might help with sleep problems caused by irregular schedules. Like any medication, it can have side effects, mainly related to feeling sleepy. Participants should pay attention to how they feel if they choose to join the trial. ^{1 2 3 4 5}

Why do researchers think this study treatment might be promising for shift work sleep disorder?

Lemborexant is unique because it targets the orexin system, which plays a key role in regulating sleep and wakefulness. Unlike traditional treatments for Shift Work Sleep Disorder, such as melatonin supplements or stimulants like modafinil, lemborexant works by inhibiting orexin receptors, which can promote sleep without the stimulating effects. Researchers are excited about this treatment because it has the potential to improve sleep quality and help individuals adapt better to irregular work hours. Additionally, its administration as a simple film-coated tablet makes it easy to use, potentially increasing adherence.

What evidence suggests that lemborexant might be an effective treatment for shift work sleep disorder?

Research has shown that lemborexant, which participants in this trial may receive, can improve sleep quality. Studies have found that it helps people fall asleep faster and stay asleep longer compared to a placebo. This medication affects certain parts of the brain that control sleep, which can benefit those with sleep problems. While most research focuses on insomnia, the positive results suggest it might also help people with shift work sleep disorder. Although specific data on shift workers is limited, existing evidence supports its potential to improve sleep. ^{3 5 6 7 8}

Are You a Good Fit for This Trial?

This trial is for individuals with sleep disorders linked to their work schedules, like shift workers who struggle to sleep during the day. Participants should be healthy adults willing to follow a simulated night shift schedule in a lab setting.

Inclusion Criteria

Be willing and able to give informed consent for study participation

Self-reported bedtime was between 9 pm and midnight on 4-7 nights per week

I will use effective contraception during and for 30 days after the study.

Exclusion Criteria

Participation in any other trial within 30 days before the screening visit

Individuals may be excluded from participating in the study based on the clinician's judgement

I have not traveled across more than one time zone in the month before screening or during the study.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2 weeks

2 visits (in-person)

Treatment

Participants undergo a 3-day simulated night shift protocol in the lab under constant monitoring, receiving either lemborexant or placebo in a double-blind, counterbalanced order

4 days per visit, with a 2-week washout period between visits

2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Lemborexant

Trial Overview The study tests if taking 5 mg of Lemborexant helps improve daytime sleep without causing drowsiness when awake. It's compared against a placebo over three days under lab conditions with constant monitoring.

How Is the Trial Designed?

Group I: Active treatment condition Active Control 1 Intervention

Lemborexant at a 5mg dose is delivered in a film-coated tablet

Group II: Placebo condition Placebo Group 1 Intervention

Placebo is delivered in a film-coated tablet

Lemborexant is already approved in United States, Canada, Japan for the following indications:

Approved in United States as Dayvigo for:

• Insomnia characterized by difficulties with sleep onset and/or sleep maintenance in adults

Approved in Canada as Dayvigo for:

• Insomnia characterized by difficulties with sleep onset and/or sleep maintenance, with or without associated impairment in daily functioning

Approved in Japan as Dayvigo for:

• Treatment of insomnia

Who Is Running the Clinical Trial?

Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal

Lead Sponsor

Trials

17

Recruited

4,600+

Published Research Related to This Trial

Lemborexant has been shown to significantly reduce the time it takes to fall asleep compared to placebo and is also effective when compared to the active control zolpidem ER, based on two phase 3 trials.

The medication is generally well-tolerated, with fewer severe side effects like cognitive impairment and complex sleep-related behaviors compared to traditional insomnia treatments, making it a suitable option, especially for older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Review of the Efficacy and Safety of Lemborexant, a Dual Receptor Orexin Antagonist (DORA), in the Treatment of Adults With Insomnia Disorder. Waters, K.[2022]

Lemborexant, a new treatment for insomnia, is primarily eliminated through metabolism, with 86.5% of the administered dose recovered in urine and feces, indicating effective processing by the body.

The study found that while lemborexant and its metabolites have similar binding affinities for orexin receptors, the metabolites are unlikely to contribute significantly to its sleep-promoting effects due to limited brain penetration, supporting its safety profile.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disposition and Metabolism of [14C]Lemborexant in Healthy Human Subjects and Characterization of Its Circulating Metabolites. Ueno, T., Ishida, T., Aluri, J., et al.[2022]

In a phase 3 trial involving 321 subjects, those who initially received placebo for 6 months showed improvements in sleep outcomes, but further enhancements were observed when switched to lemborexant (LEM) treatment, particularly in sleep onset latency and total sleep time.

Among participants who did not respond to placebo, 11%-15% experienced positive effects from lemborexant after switching, indicating that lemborexant can provide additional benefits even after prior treatment with placebo.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and safety of lemborexant in subjects previously treated with placebo for 6 months in a randomized phase 3 study. Yardley, J., Inoue, Y., Pinner, K., et al.[2023]

Shift work disorder (SWD) affects up to 2 million Americans and is linked to serious health issues like cardiovascular diseases, depression, and increased risk of accidents.

Treatment options for SWD include behavioral strategies and pharmacologic interventions like modafinil and armodafinil, which have been shown to effectively reduce insomnia and excessive sleepiness, improving alertness during work shifts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is shift work making your patient sick? Emerging theories and therapies for treating shift work disorder. Rosenberg, R., Doghramji, PP.[2011]

Melatonin effectively phase shifts circadian rhythms, making it a useful treatment for sleep disorders related to circadian misalignment, such as jet lag and shift work.

In specific conditions like delayed sleep phase syndrome (DSPS) and non-24-hour sleep-wake disorder, melatonin has been shown to advance sleep onset and improve overall sleep quality compared to placebo.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of melatonin in the treatment of phase shift and sleep disorders. Skene, DJ., Lockley, SW., Arendt, J.[2019]

Circadian rhythm sleep-wake disorders (CRSWDs) affect millions and significantly impact quality of life, highlighting a critical need for effective treatments.

Melatonin receptor agonists, particularly tasimelteon, have shown promise in treating CRSWDs, with distinct pharmacologic profiles that may guide their clinical use, though further research is necessary to fully understand their therapeutic potential.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative Review of Approved Melatonin Agonists for the Treatment of Circadian Rhythm Sleep-Wake Disorders. Williams, WP., McLin, DE., Dressman, MA., et al.[2022]

In a study of 61 patients over 3 months, switching to lemborexant significantly reduced insomnia symptoms, as measured by the Athens Insomnia Scale, indicating its efficacy as a treatment for insomnia.

The study also found that switching to lemborexant helped decrease the use of benzodiazepines and Z-drugs, potentially reducing the associated risks of these medications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Switching to lemborexant for the management of insomnia in mental disorders: the SLIM study. Horikoshi, S., Miura, I., Suzuki, Y., et al.[2023]

Lemborexant, an orexin receptor antagonist approved for insomnia, was studied in a large population of 1,892 subjects, showing that its pharmacokinetics are influenced by factors like body mass index and age, particularly in older adults.

The incidence of treatment-emergent adverse events (TEAEs) with lemborexant was low (3% to 8%) and similar to placebo, indicating that it can be safely administered without requiring dose adjustments based on patient characteristics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Population Pharmacokinetics and Exposure-Response Analyses for the Most Frequent Adverse Events Following Treatment With Lemborexant, an Orexin Receptor Antagonist, in Subjects With Insomnia Disorder. Lalovic, B., Majid, O., Aluri, J., et al.[2021]

In a study involving 23 patients with Delayed Sleep-Wake Phase Disorder (DSWPD), administering an ultra-low dose of ramelteon (median 0.571 mg) in the early evening significantly advanced their sleep schedules and improved clinical symptoms.

Most patients had previously tried normal doses of ramelteon, suggesting that lower doses may be effective and potentially safer for managing DSWPD, especially in cases where traditional melatonin is not available or reliable.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultra-low-dose early night ramelteon administration for the treatment of delayed sleep-wake phase disorder: case reports with a pharmacological review. Shimura, A., Kanno, T., Inoue, T.[2023]

In a study involving 291 adults with insomnia, lemborexant doses of 2.5 to 10 mg significantly improved sleep efficiency and reduced sleep onset latency compared to placebo, while minimizing next-morning sleepiness.

The 15 mg dose of lemborexant was particularly effective, leading to early success in the trial, and was associated with mostly mild to moderate side effects like somnolence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lemborexant, A Dual Orexin Receptor Antagonist (DORA) for the Treatment of Insomnia Disorder: Results From a Bayesian, Adaptive, Randomized, Double-Blind, Placebo-Controlled Study. Murphy, P., Moline, M., Mayleben, D., et al.[2018]

Lemborexant is a dual orexin receptor antagonist approved in December 2019 for treating insomnia in adults, effectively helping with both sleep onset and maintenance.

In addition to its use for insomnia, lemborexant is being studied for treating irregular sleep-wake rhythm disorder in patients with mild to moderate Alzheimer's disease, indicating its potential broader applications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lemborexant: First Approval. Scott, LJ.[2021]

Tasimelteon is a melatonin receptor agonist that effectively reduces sleep onset latency and resets circadian rhythms, making it a potential treatment for jet lag, shift work, and circadian rhythm sleep disorders, as shown in phase II and III clinical trials.

The drug is well tolerated and does not impair next-day functioning or cause dependence, indicating a favorable safety profile for short-term use, although long-term safety data is still needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tasimelteon, a melatonin agonist for the treatment of insomnia and circadian rhythm sleep disorders. Hardeland, R.[2013]

In a 12-month phase 3 study involving 949 subjects with moderate to severe insomnia, lemborexant significantly reduced insomnia severity compared to placebo, with improvements maintained over time.

Lemborexant treatment resulted in higher rates of clinically meaningful responses and remissions, with 44%-57% of subjects achieving a significant reduction in insomnia severity after 1 to 6 months, compared to 30%-41% in the placebo group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of lemborexant treatment on insomnia severity: analyses from a 12-month study of adults with insomnia disorder. Roth, T., Rosenberg, R., Morin, CM., et al.[2022]

Citations

1. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK596596/

Clinical Review - Lemborexant (Dayvigo) - NCBI - NIH Overall, LEM appears to be effective relative to PBO for important sleep-related outcomes, and long-term results from SUNRISE 2 supported those observed during ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06496282

Lemborexant on Improving Sleep Quality Among Hospital ... At the present there are limited information regarding the effectiveness of medications used to promote sleep in shift workers. Lemborexant is ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT05344443

NCT05344443 | Lemborexant Shift Work Treatment Study Insomnia and daytime sleepiness are common complaints among night shift workers, but effective sleep treatments in shift workers are lacking.

4. psychiatrist.com psychiatrist.com/wp-content/uploads/2025/01/lemborexant-daytime-functioning-adults-insomnia-24m03810.pdf

lemborexant-daytime-functioning-adults-insomnia- ... 17–19 The results showed that sleep onset and sleep maintenance were significantly improved in subjects treated with LEM compared with placebo.

5. clinicaltrials.ucsf.edu clinicaltrials.ucsf.edu/trial/NCT05344443

Lemborexant Shift Work Treatment Study Effective sleep treatments in shift workers are lacking. However, a recent randomized study of Suvorexant (20mg), a hypocretin/orexin receptor ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11315815/

Safety and Efficacy of Lemborexant in Insomnia Patients A prospective, postmarketing observational study was conducted to evaluate the safety and efficacy of lemborexant (LEM) tablets in daily clinical practice in ...

7. clinicaltrials.gov clinicaltrials.gov/study/NCT05344443

NCT05344443 | Lemborexant Shift Work Treatment Study Insufficient sleep among night shift and rotating shift workers is linked with significant health consequences, including elevated risk for cardiovascular ...

8. accessdata.fda.gov accessdata.fda.gov/drugsatfda_docs/nda/2019/212028Orig1s000RiskR.pdf

Risk Assessment and Risk Mitigation Review(s) The primary safety concern associated with the use of lemborexant is somnolence and the potential for next day impairment. The risk is increased ...