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Sulthiame, a unique oral carbonic anhydrase inhibitor, relieves the symptoms of the most common sleep-related breathing disorder through biochemical pathways, potentially improving patient compliance and offering additional benefits like blood pressure reduction.
A pioneering study presented at the European Respiratory Society Congress 2024 has discovered that Sulthiame, an epilepsy medication, could significantly alleviate symptoms of obstructive sleep apnea (OSA). Data from nearly 300 participants suggest that this oral drug may reduce sleep-disordered breathing, a condition that currently relies heavily on mechanical therapies like continuous positive airway pressure (CPAP), which sees adherence rates plummet below 50% after just a few years.
Researchers highlighted the need for more tolerable treatments, noting that medication could enhance patient compliance. Sulthiame's ability to modify carbonic anhydrase activity may play a crucial role in addressing OSA. Earlier trials have indicated its safety and efficacy, prompting further investigation into the optimal dosage.
In the study under focus, 298 adults (mean age=56 years) with OSA who struggled with traditional therapies were randomized to receive Sulthiame 100 mg, 200 mg, or 300 mg given daily, or a placebo. The findings were promising: patients receiving 100 mg, 200 mg and 300 mg saw decreases in their apnea/hypopnea index (AHI) of up to 17.8%, 34.8%, and 39.9%, correspondingly. Doses of 200-300 mg had peak effectiveness, exhibiting similar outcomes for patients with moderate and severe OSA. The key findings have been summarized below:
While the study's results were consistent with prior research, the investigators were pleased with the therapy's effectiveness and its potential to lower blood pressure in patients, emphasizing the need for further exploration.
The small sample size indicates a need for larger trials to evaluate long-term efficacy and tolerability. Nonetheless, the findings support Sulthiame as a promising and well-tolerated candidate for OSA treatment, justifying phase 3 studies.
Oral option with exciting developments, but caution is advised
Although CPAP machines are said to be the best practice for treating sleep-related breathing disorders, their effectiveness is limited by patient tolerance. Currently, there are no effective oral treatments for OSA, making the development of a pill a significant leap that could help more patients and decrease complications from untreated OSA.
The American Academy of Sleep Medicine has not suggested carbonic anhydrase inhibitors like Acetazolamide and Sulthiame as they have shown limited success in treating OSA. Emerging evidence suggests that nonanatomic factors, such as high loop gain, may influence treatment outcomes, leaving the role of these inhibitors uncertain.
Even though a nearly 40% reduction in the AHI at the highest dose of Sulthiame has been found, many patients still experience moderate OSA. Future research is awaited to recognize effective patient groups, evaluate long-term effects, and outcomes across different OSA phenotypes.
Medscape
Oral Epilepsy Drug Eases Symptoms of OSA
Heidi Splete
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