Dr Michael Thorpy: The Exciting Future of Orexin Agonists for Idiopathic Hypersomnia

Michael Thorpy, MD, professor of neurology, Albert Einstein College of Medicine, discusses the hopeful future of treatment in idiopathic hypersomnia.

Michael Thorpy, MD, professor of neurology, Albert Einstein College of Medicine, joined The American Journal of Managed Care® for an interview to discuss the future of treatment for patients with idiopathic hypersomnia. In this realm, the emergence of orexin agonists has brought great benefits to this patient population; however, as Thorpy notes, there is more nuance to consider as these medications are developed with varying risks of adverse effects.

The latest research in sleep disorder treatment was presented at the 2024 SLEEP: American Academy of Sleep Medicine and Sleep Research Society Annual Meeting.

This transcript has been lightly edited.


What future directions do you foresee for pharmacological research in idiopathic hypersomnia, and are there any emerging trends or technologies that might significantly impact this field?

I think the most exciting thing with regards to pharmacological treatment of idiopathic hypersomnia is the potential application of the orexin agonists. We understand that this neuropeptide in the brain called orexin, also goes under another name called hypercretin, it's a very important neuropeptide that stimulates weight-promoting centers in the brain. It's really the most important biochemical factor that's been discovered in the last 50 years with regards to sleep. And so, the new medications that help to add to the effect of the orexin in the brain by stimulating weight-promoting areas is a very exciting area.

Unfortunately, there are no medications out at the moment. There are quite a number of different companies that are investigating these orexin agonists to try to find the one that's going to be effective without having any adverse effects. Unfortunately, a couple of studies have had to be terminated because they have found that orexin agonists, although they are extremely effective at improving alertness during the daytime, they've come at the cost of having some side effects.

But we still have quite a number of new agents available that are under investigation at the present time, and hopefully, we will be able to discover an agent that is very effective at improving alertness, that can be useful, not only for narcolepsy, but for idiopathic hypersomnia. This will make a very big difference to our management going forward. So, we're quite excited about these new orexin agonists that are potentially coming up in the near future.

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