TOPLINE

Adults with insomnia who used dual orexin receptor antagonists (DORAs) did not have increased odds of falls or fractures, although the evidence was limited and of moderate certainty.

METHODOLOGY

• Researchers conducted a systematic review and meta-analysis to assess whether the use of DORAs was associated with a likelihood of falls and fractures among adults with insomnia.
• They searched multiple databases through August 2025 and included 19 studies from various countries; of these, 10 were randomized controlled trials and nine were observational studies, with pooled data from 183,595 participants (mean age, 67.9 years; 49% women).
• The reviewed DORA drugs were almorexant, lemborexant, daridorexant, suvorexant, and filorexant, which were compared with placebo or no use of DORAs.
• Primary outcomes were the occurrence of falls and fractures. For randomized trials, the duration of follow-up ranged from 3 to 54 weeks.

TAKEAWAY

• Pooled data from 19 studies showed no significant association between the use of DORAs and odds of falls, with a heterogeneity of 59%.
• Randomized controlled trials alone showed 41% lower odds of falls among participants who received DORAs vs placebo (odds ratio, 0.59; 95% CI, 0.35-0.98), a benefit not replicated in observational studies.
• Two studies reported fracture outcomes and found no significant association between the use of DORAs and odds of fractures, with no heterogeneity.
• The randomized trials had a risk for bias ranging from low to some concerns, whereas the observational studies had a moderate-to-serious risk for bias. Overall, the evidence was rated as moderate in certainty.

IN PRACTICE

"If truly safer and effective, DORAs would represent an important alternative to sedative-hypnotics, which continue to be prescribed despite recommendations as being potentially inappropriate in older adults according to the American Geriatrics Society (AGS) Beers Criteria," the researchers wrote.

SOURCE

The study was led by Arianna Paolone of Royal College of Surgeons in Ireland in Dublin, Ireland. It was published online on September 26 in the Journal of the American Geriatrics Society.

LIMITATIONS

The certainty of evidence was limited by a low number of events. A large proportion of data came from Japan. The dosage of drugs and treatment duration varied across studies.

DISCLOSURES

The authors did not declare a specific funding source for the study and declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.