REVIEW OF: Surman C et al, J Clin Psychiatry 2023;84(6):23m14934

STUDY TYPE: Randomized double-blind placebo-controlled trial

Solriamfetol (Sunosi), an FDA-approved medication for narcolepsy and obstructive sleep apnea, has a similar mechanism of action as bupropion (dopamine-norepinephrine reuptake inhibition). This raises the question of its potential as a nonstimulant treatment for ADHD.

In this industry-funded, double-blind, placebo-controlled trial, 60 adults with ADHD, excluding those with “conditions that obscured determination of an ADHD diagnosis,” were randomized to receive either solriamfetol 75 mg or a placebo for six weeks. The study, conducted remotely, involved weekly self-monitored blood pressure checks and virtual meetings with investigators to complete the Adult ADHD Investigator Symptom Rating Scale (AISRS). If tolerated, solriamfetol was increased to 150 mg, aligning with dosages recommended for narcolepsy and obstructive sleep apnea.

From the third through the sixth weeks of the study, mean improvement on the AISRS was significantly greater for the solriamfetol group than for the placebo group. By the end of the study, 45% of participants in the treatment arm, versus 6.9% of those who got the placebo, achieved what the study considered treatment response. This was predefined as a 25% or greater reduction in their total AISRS score and a Clinical Global Impressions score indicating “much” or “very much” improved. There was no significant difference in mean heart rate, blood pressure, or adverse events between the two groups.

CARLAT TAKE

This relatively small, industry-funded study suggests that solriamfetol may treat ADHD. However, it is only available as an expensive, brand-name medication, hasn’t been approved for ADHD, and lacks long-term data for this indication. It’s unclear that it offers meaningful advantages over bupropion.