World Sleep 2022 | Orexin, narcolepsy and future treatment

Emmanuel Mignot, MD, PhD, Stanford University Center for Sleep Sciences, Palo Alto, CA, discusses orexin as a predominant factor in the development of narcolepsy type 1. In typical cases of narcolepsy, patients do not possess any orexin; the cells that synthesize orexin are destroyed and thus portray the worst syndrome. Prof. Mignot states that it is an exciting time for narcolepsy research; there have been drugs that target the orexin system and thus, prevent the loss of orexin neurons in narcolepsy type 1. Companies are developing agonists which stimulate the neural receptors. Some preliminary results have been released from one drug developed called TAK-925 – results have been positive, eliminating the onset of narcolepsy. TAK-925 appears to be the most effective drug available for treating narcolepsy type-1; a test was conducted where patients were kept awake for 40 minutes. People with narcolepsy fell asleep within 2 minutes – with existing drugs, these people could stay awake for around 15 minutes – however, with TAK-925, individuals with narcolepsy could stay awake for the full duration of the test. This demonstrated the effectiveness of TAK-925 in treating narcolepsy. Prof. Mignot continues to say that the first drug developed was administered by IV, then further developed as an orally administered variant (TAK-994) – unfortunately, the clinical trial (NCT04820842) was stopped due to adverse side effects . This interview took place at the World Sleep Conference in Rome, Italy.