Sleep medicine · 2026
Perceived effectiveness, tolerability, and discontinuation of lemborexant in real-world use: Evidence from online patient reports.
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Armanious Abanoub J, Dunn Alexandra R, Martin Caitlin E, James Morgan H
Аннотация
BACKGROUND: Lemborexant is a dual orexin receptor antagonist (DORA) approved for the clinical management of insomnia. Clinical trials indicate that lemborexant improves sleep onset latency and sleep maintenance, with mild somnolence as the most common side effect. However, there is limited real-world evidence characterizing patient experiences with lemborexant, including perceived benefits, side effects, and overall treatment satisfaction, and how these factors influence treatment adherence and discontinuation.
METHODS: We conducted a mixed-methods infoveillance study analyzing publicly available user-generated online content describing experiences with lemborexant. A total of 260 online reviews were subjected to reflexive thematic analysis to identify themes relating to user-reported benefits, adverse effects, and broader treatment-related experiences. We examined how these themes were associated with self-reported efficacy ratings (1-10 scale) and intention to continue or discontinue treatment.
RESULTS: Approximately one third (30%) of respondents described meaningful improvements in sleep quality following initiation with lemborexant; half (50%) reported minimal or no perceived benefit. Two-thirds (68%) of respondents reported at least one adverse outcome associated with treatment; the most frequently reported were exacerbated oneiric experiences (e.g., vivid dreams or nightmares) and worsening of sleep quality. Lower efficacy ratings and discontinuation intent were most strongly associated with self-reported sleep paralysis, intensified oneiric phenomena, and next-day somnolence. Longer treatment duration was associated with higher perceived efficacy ratings.
CONCLUSIONS: Patient-reported experiences with lemborexant reveal marked variability in perceived benefit and tolerability. Dream-related phenomena emerged as particularly salient themes in shaping respondents' overall perceptions of lemborexant and intent to continue vs. discontinue treatment. Together, these findings highlight the value of real-world infoveillance approaches for capturing patient-centered treatment experiences that may be underrepresented in structured clinical trial and postmarketing surveillance data.
METHODS: We conducted a mixed-methods infoveillance study analyzing publicly available user-generated online content describing experiences with lemborexant. A total of 260 online reviews were subjected to reflexive thematic analysis to identify themes relating to user-reported benefits, adverse effects, and broader treatment-related experiences. We examined how these themes were associated with self-reported efficacy ratings (1-10 scale) and intention to continue or discontinue treatment.
RESULTS: Approximately one third (30%) of respondents described meaningful improvements in sleep quality following initiation with lemborexant; half (50%) reported minimal or no perceived benefit. Two-thirds (68%) of respondents reported at least one adverse outcome associated with treatment; the most frequently reported were exacerbated oneiric experiences (e.g., vivid dreams or nightmares) and worsening of sleep quality. Lower efficacy ratings and discontinuation intent were most strongly associated with self-reported sleep paralysis, intensified oneiric phenomena, and next-day somnolence. Longer treatment duration was associated with higher perceived efficacy ratings.
CONCLUSIONS: Patient-reported experiences with lemborexant reveal marked variability in perceived benefit and tolerability. Dream-related phenomena emerged as particularly salient themes in shaping respondents' overall perceptions of lemborexant and intent to continue vs. discontinue treatment. Together, these findings highlight the value of real-world infoveillance approaches for capturing patient-centered treatment experiences that may be underrepresented in structured clinical trial and postmarketing surveillance data.