2025 American Academy of Neurology Abstract Website

Giovanna Pontirolli¹, Manuela Teles², Barbara Antonia Talah³, Julia Mello⁴, Larissa Tanimoto⁵, Paulo Cruz⁶, Andressa Cardoso¹, Francisco Jose Germano Hennemann⁷
¹Universidade Nove de Julho, ²Universidade Estadual do Amazonas, ³Pontifícia Universidade Católica do Paraná, ⁴Pontifícia Universidade Católica de São Paulo, ⁵Universidad de Buenos Aires, ⁶Universidade Federal do Pará, ⁷Universidade de Taubaté

Objective:

This study aims to evaluate the efficacy of suvorexant in preventing delirium in hospitalized patients through a systematic review and meta-analysis.

Background:

Delirium is a common and serious complication among hospitalized patients, particularly in the postoperative period. Preventive strategies are crucial to reduce its incidence and associated morbidity. Suvorexant, an orexin receptor antagonist, has emerged as a potential agent in the prevention of delirium. Moreover, its association with Ramelteon, a melatonin receptor agonist, has shown even more promising results.

Design/Methods:

We searched in the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs), and observational studies that evaluated the efficacy of suvorexant in preventing delirium in hospitalized patients, particularly postoperatively. Pooled analyses were conducted using random effects models with 95% confidence intervals (CI). Statistical analysis was performed using the RStudio Software, version 4.4.1.

Results:

A total of 3 RCTs, and 9 observational studies with 3,547 patients evaluated Suvorexant versus control. Suvorexant reduced delirium incidence (14.12% vs. 26.17%; OR 0.51; 95% CI 0.39 to 0.67; p=0.000001; I²=0%), and Ramelteon with Suvorexant reduced it even further (25.71% vs. 39.14%; OR 0.26; 95% CI 0.17 to 0.38; p<0.000001; I²=0%). Hospital mortality showed no significant difference between groups (4.21% vs. 9.58%; OR 1.22; 95 % CI 0.21 to 7.3; p=0.825; I²=81%). ICU stay was also non-significant (MD -0.25 days; 95% CI -1.11 to 0.62; p=0.573, I²=66%). Ventilation time was reduced by 4.26 hours (MD -4.26h; 95% CI -8.04 to -0.47; p=0.027; I²=95%). Time to delirium showed no statistic difference (MD -0.03 days; 95% CI -1.31 to 1.26; p=0.966; I²=89%).

Conclusions:

This meta-analysis suggests that suvorexant was considered effective in reducing the incidence of delirium in hospitalized patients, particularly in postoperative settings.