

CLINICAL DATA IN IDIOPATHIC HYPERSOMNIA (IH)
XYWAV was studied in adult patients
with IH in a pivotal phase III trial and
a phase IV open-label, single-arm
interventional study1-3
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PHASE III
Before taking a look at the phase IV data, be sure to review findings from the phase III study.
XYWAV was evaluated in a phase III, double-blind, placebo-controlled, randomized-withdrawal, multicenter study of 154 adults with IH aged 19 to 753
XYWAV has been evaluated across these efficacy measures:
- Epworth Sleepiness Scale
(ESS)—Assesses excessive daytime sleepiness (EDS) or patient perceptions of likelihood they will fall asleep during usual daily activities.3 See ESS data - Patient Global Impression of Change (PGIc)—Assesses patient perceptions of symptom change from "very much improved" to "very much worse."3 See PGIc data
- Idiopathic Hypersomnia Severity Scale (IHSS)—Assesses the severity of idiopathic hypersomnia symptoms, such as excessive sleepiness, prolonged sleep duration, cognitive impairment, and sleep inertia.3 See IHSS data
- Evaluated in adults: 154 patients, aged 19 to 75 (median age 39 years)3
- Treatment background (at study entry): Trial included patients (N=154) who were taking wake-promoting agents (WPAs) or stimulants only (54%), treatment-naive (41%), taking sodium oxybate plus a WPA or stimulant (4%), taking sodium oxybate only (2%)3
- Dosing regimens: Participants took either a twice-nightly or a once-nightly regimen at the discretion of the clinician according to the clinical presentation of each patient. Approximately 57% of patients continued taking a stable dose of stimulant along with XYWAV throughout the SDP and DB RWP3
- Baseline disease severity (based on CGI-S): Trial included patients (N=154) who were borderline to mildly ill (4%), moderately to markedly ill (77%), severely to extremely ill (20%)1
- Sleep time* (at baseline): Trial included patients (N=154) with long sleep time and without long sleep time; 20% and 80%, respectively1
- Over 6 months (204 days) mean exposure to XYWAV in safety population: Included titration, stable-dose period, randomized withdrawal period, and open-label extension3
*Long sleep time based on ICSD-2 or ICSD-3 criteria.4
CGI-S = Clinical Global Impression of Severity; DB RWP = Double-Blind, Randomized-Withdrawal Period; ICSD = International Classification of Sleep Disorders; OLE = Open-Label Extension; OTTP = Open-Label Treatment Titration and Optimization Period; SDP = Stable-Dose Period.
Efficacy in EXCESSIVE daytime sleepiness (as measured by ESS)1,3
Significant worsening of daytime sleepiness in patients randomized to placebo during the 2-week, double-blind, randomized withdrawal period1,3
Mean ESS score remained stable from the end of the SDP through the end of the 2-week DB RWP with XYWAV—but worsened with placebo1,3
ESS scores higher than 10 are indicative of excessive daytime sleepiness.5
Limitations: Trial was not designed to demonstrate efficacy during the OTTP; all patients were taking active drug while dose was being titrated to individual optimized dose; no conclusions can be drawn about the effect of XYWAV during this period.
*LS mean difference between XYWAV and placebo in the change in ESS score from end of 2-week SDP to end of 2-week DB RWP
DB RWP = Double-Blind, Randomized-Withdrawal Period; ESS = Epworth Sleepiness Scale; LS = Least Squares; OTTP = Open-Label Treatment Titration and Optimization Period;
SDP = Stable-Dose Period.
patient perception of change in symptoms (as measured by PGIc)1,3
Significantly more patients reported worsening* of IH overall when randomized to placebo during the 2-week, double-blind, randomized withdrawal period1,3
Percentage of patients reporting worsening* IH overall at the end of the 2-week DB RWP1,3
of patients continuing treatment with XYWAV reported improvement† or no change in their overall idiopathic hypersomnia at the end of DB RWP (compared to how they felt during the stable-dose period)
*Worsening of idiopathic hypersomnia defined as "minimally, much worse, or very much worse" PGIc scores.3
†Improvement of idiopathic hypersomnia defined as "minimally, much, or very much improved" PGIc scores.1
DB RWP = Double-Blind, Randomized-Withdrawal Period; PGIc = Patient Global Impression of Change.
Efficacy in IDIOPATHIC HYPERSOMNIA symptom severity (as measured by IHSS SCORE)1,3
Significant worsening in IH symptom severity in patients randomized to placebo during the 2-week, double-blind, randomized withdrawal period1,3
Mean IHSS score remained stable from the end of the SDP through the end of the 2-week DB RWP with XYWAV—but worsened with placebo1,6
Limitations: Trial was not designed to demonstrate efficacy during the OTTP; all patients were taking active drug while dose was being titrated to individual optimized dose; no conclusions can be drawn about the effect of XYWAV during this period.
IHSS Score Ranges7
*Estimated median difference between XYWAV and placebo in change in IHSS from end of SDP to end of DB RWP1
DB RWP = double-blind, randomized withdrawal period; IHSS = Idiopathic Hypersomnia Severity Scale; OTTP = open-label treatment titration and optimization period; SDP = stable-dose period.
PHASE IV
DUET, a phase IV, prospective, multicenter, single-arm, open-label, multiple-cohort study evaluated nighttime sleep and daytime symptoms in patients with IH taking XYWAV2
Evaluated in adults: 46 patients with IH aged 20 to 68 (median age 37.5 years)2
Dosing Regimen: Participants took either a twice-nightly or a once-nightly regimen at the discretion of the clinician according to the clinical presentation of each patient2
IH cohort enrollment criteria2:
- 18-75 years of age
- Primary diagnosis of idiopathic hypersomnia (ICSD-3)
- Clinically significant EDS*
- If taking an alerting agent, stable dosage ≥1 month prior to and no adjustments during the study period
*If not currently taking an oxybate medication, ESS score >10 at screening (visit 1); if currently taking an oxybate medication, had ESS score >10 at baseline (visit 2, after washout period).2
Symptoms were evaluated using multiple measures, including:
- Primary endpoint: Epworth Sleepiness Scale (ESS)—Assesses excessive daytime sleepiness (EDS) or patient perceptions of likelihood they will fall asleep during usual daily activities2
- Select secondary endpoint: Idiopathic Hypersomnia Severity Scale (IHSS)—Assesses the severity of IH symptoms including excessive sleepiness, prolonged sleep duration, cognitive impairment, and sleep inertia2
- Select secondary endpoint: Patient Global Impression of Change (PGIc)—Assesses patient perceptions of symptom change from “very much improved” to “very much worse”2
- Select exploratory endpoints: Polysomnography—Records physiological electrodes during sleep; scored to describe sleep architecture, percentage and duration of sleep stages, sleep stage transitions, nocturnal awakenings and arousals, and other measures8
Limitations: Open-label design and the lack of a control cohort restrict the ability to attribute the findings solely to XYWAV. Results shown are descriptive in nature.2
DUET is the first prospective evaluation of PSG outcomes in patients
with idiopathic hypersomnia treated with low‑sodium oxybate.8
Change in excessive daytime sleepiness (as measured by ESS)2
Mean change in ESS from baseline to end of treatment2
Limitations: Open-label design and the lack of a control cohort restrict the ability to attribute the findings solely to XYWAV. Results shown are descriptive in nature.2
Completer set includes all participants who enrolled in the study, took ≥1 dose of the study drug after the baseline period, completed the stable-dose period, and completed the polysomnography end-of-treatment visit.2
CI = Confidence Interval; ESS = Epworth Sleepiness Scale; LS = Least Squares; SE = Standard Error.
Change in IHSS score2
Mean change in IHSS from baseline to end of treatment2
Limitations: Open-label design and the lack of a control cohort restrict the ability to attribute the findings solely to XYWAV. Results shown are descriptive in nature.2
Completer set includes all participants who enrolled in the study, took ≥1 dose of the study drug after the baseline period, completed the stable-dose period, and completed the polysomnography end-of-treatment visit.2
*Not all participants completed all assessments.2
CI = Confidence Interval; IHSS = Idiopathic Hypersomnia Severity Scale; LS = Least Squares; SE = Standard Error.
Patient-reported outcomes (PGIc)2
PGIc for overall disease and PGIc for sleep inertia at end of treatment2
Limitations: Open-label design and the lack of a control cohort restrict the ability to attribute the findings solely to XYWAV. Results shown are descriptive in nature.2
Completer set includes all participants who enrolled in the study, took ≥1 dose of the study drug after the baseline period, completed the stable-dose period, and completed the polysomnography end-of-treatment visit. Categories with values of 0 are not shown.2
*Not all participants completed all assessments.2
PGIc = Patient Global Impression of Change.
Polysomnography (PSG)
Limitations: Open-label design and the lack of a control cohort restrict the ability to attribute the findings solely to XYWAV. Results shown are descriptive in nature.2
LS = Least Squares; SE = Standard Error.
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Key efficacy endpoints in the pivotal phase III study
References:
- Dauvilliers Y, Arnulf I, Foldvary‑Schaefer N, et al. Safety and efficacy of lower‑sodium oxybate in adults with idiopathic hypersomnia: a phase 3, placebo‑controlled, double‑blind, randomised withdrawal study. Lancet Neurol. 2022;21(1):53‑65.
- Plante DT, Cairns A, Schneider LD, et al. Effectiveness and safety of low‑sodium oxybate in participants with idiopathic hypersomnia: primary results from the DUET study. CNS Drugs. 2026. Published online March 14, 2026.
- XYWAV® (calcium, magnesium, potassium, and sodium oxybates). Prescribing Information. Palo Alto, CA: Jazz Pharmaceuticals, Inc.
- American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
- Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540‑545.
- Data on File (REF‑8066). Palo Alto, CA: Jazz Pharmaceuticals, Inc.
- Rassu AL, Evangelista E, Barateau L, et al. Idiopathic Hypersomnia Severity Scale to better quantify symptoms severity and their consequences in idiopathic hypersomnia. J Clin Sleep Med. 2022;18(2):617‑629.
- Nichols DA, Steininger TL, Fuller DS, et al. A patient‑centric clinical trial design to comprehensively evaluate low‑sodium oxybate in people with idiopathic hypersomnia or narcolepsy. Neurol Ther. 2025;14(4):1705‑1727.
- Data on File (REF‑23238). Palo Alto, CA: Jazz Pharmaceuticals, Inc.
