Choosing and Optimizing Therapy in Narcolepsy

This activity is part of a series


Phyllis C. Zee, MD, PhD
Director, Center for Circadian and Sleep Medicine
Chief of Sleep Medicine in the Department of Neurology
Benjamin and Virginia T. Boshes Professor of Neurology
Professor of Neurology (Sleep Medicine)
Northwestern University Feinberg School of Medicine
Chicago, IL
Phyllis C. Zee, MD, PhD

Phyllis C. Zee, MD, PhD, is the Benjamin and Virginia T. Boshes Professor in Neurology and Professor of Neurobiology at Northwestern University. She is also the Director of the Center for Circadian and Sleep Medicine (CCSM) and Chief of the Division of Sleep Medicine at Northwestern University’s Feinberg School of Medicine. As Director of CCSM, Dr. Zee oversees an interdisciplinary program in basic and translational sleep and circadian rhythm research, and findings from her team have paved the way for innovative approaches to improve sleep and circadian health.

A central theme of Dr. Zee’s research program is understanding the role of circadian-sleep interactions on the expression and development of cardiometabolic and neurologic disorders. Her research has focused on the effects of age and neurodegeneration on sleep and circadian rhythms and pathophysiology of sleep-wake disorders. In addition, her laboratory is studying the effects of circadian-sleep–based interventions, such as exercise, bright light, and feed-fast schedules on cognitive, cardiovascular, and metabolic functions and their potential to delay cardiometabolic aging and neurodegeneration.

Dr. Zee also has authored more than 300 peer-reviewed original articles, reviews, and chapters on the topics of sleep, circadian rhythms, and sleep/wake disorders. She has also trained over 50 pre-doctoral and post-doctoral students and has mentored numerous faculty members. Dr. Zee is a fellow of the American Academy of Sleep Medicine, a member of the American Academy of Neurology, and a member of the American Neurological Association. She has served on numerous national and international committees, NIH scientific review panels, and international advisory boards. She is past President of the Sleep Research Society, past President of the Sleep Research Foundation, past Chair of the NIH Sleep Disorders Research Advisory Board, a past member of the NIH National Heart Lung and Blood Disorders Advisory Council, and the current President-Elect of the World Sleep Society. Dr. Zee is the recipient of the 2011 American Academy of Neurology Sleep Science Award, the 2014 American Academy of Sleep Medicine academic honor, the William C. Dement Academic Achievement Award, the 2020 Sleep Research Society Distinguished Scientist Award, and the 2021 NSF Lifetime Achievement Award.

Karl Doghramji, MD, FAASM, DFAPA
Professor of Psychiatry, Neurology, and Medicine
Sidney Kimmel Medical College of Thomas Jefferson University
Medical Director, Jefferson Sleep Disorders Center
Program Director, Fellowship in Sleep Medicine
Thomas Jefferson University Hospital
Philadelphia, PA
Karl Doghramji, MD, FAASM, DFAPA

Dr. Karl Doghramji is Professor of Psychiatry, Neurology, and Medicine at Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania, and Medical Director of the Jefferson Sleep Disorders Center at Thomas Jefferson University Hospital, also in Philadelphia. He is also Program Director of the Fellowship in Sleep Medicine.

Dr. Doghramji works as a clinician, researcher, educator, and physician leader, and has a national clinical and academic reputation in sleep medicine and biological psychiatry. He is actively engaged in interdisciplinary care with academic contributions in the fields of psychiatry, sleep medicine, otolaryngology, neurology, and pulmonary medicine.

Dr. Doghramji has been the recipient of 45 grants. He has authored 214 academic publications (85 peer-refereed papers, 121 book chapters and electronic media publications, and 8 books) and 63 abstracts. He has also made 236 presentations at national and international scientific sessions, symposia, and courses, including the annual meetings of the American Psychiatric Association and the American Academy of Sleep Medicine. Dr. Doghramji serves as a reviewer for numerous medical journals.

An active member of many professional organizations, Dr. Doghramji has held numerous committee positions with the American Academy of Sleep Medicine and has served as an examiner for the American Board of Psychiatry and Neurology and the American Board of Sleep Medicine. He was elected to the American College of Psychiatrists in 1994, Fellow of the American Academy of Sleep Medicine in 1998, and Distinguished Life Fellow of the American Psychiatric Association in 2017. He has been selected by Philadelphia Magazine for the list of “Top Doctors” for 15 years and by other similar publications such as U.S. News & World Report and Castle Connolly.

Dr. Doghramji received his medical degree from Jefferson Medical College (now Sidney Kimmel Medical College) and completed his internship in internal medicine at Presbyterian-University of Pennsylvania Medical Center in Philadelphia, his residency in psychiatry at Thomas Jefferson University Hospital, and his fellowship in sleep medicine at Albert Einstein School of Medicine in New York. He is also an Academic Associate in the Adult Division of the Institute of the Psychoanalytic Center of Philadelphia.

Paul P. Doghramji, MD, FAAFP
Senior Family Physician
Collegeville Family Practice
Medical Director, Health Services
Ursinus College
Collegeville, PA
Paul P. Doghramji, MD, FAAFP

Paul P. Doghramji, MD, FAAFP, is a Senior Family Physician with Collegeville Family Practice and Medical Director of Health Services for Ursinus College in Collegeville, Pennsylvania. Dr. Doghramji earned his medical degree from Jefferson Medical College in Philadelphia, Pennsylvania and completed residency in Family Practice at Chestnut Hill Hospital. He is a member of the American Academy of Family Physicians (AAFP) and was awarded the AAFP Fellowship Degree in 2005. He is a member of the Pennsylvania Academy of Family Physicians. Dr. Doghramji has been the recipient of the American Medical Association’s Physician Recognition Award in every qualifying year for 8 years. He has extensively published his research in peer-reviewed journals such as the American Journal of Medicine, Current Medical Research and Opinion, and Postgraduate Medicine. He has authored articles for numerous websites on topics such as sleep disorders, gout, rheumatoid arthritis (RA), biology of leg disorders, depression, chronic pain, health literacy, and diabetes. He is a co-author of the textbook Clinical Management of Insomnia, now in its second edition.

Julie Flygare, JD
President & CEO, Project Sleep, Los Angeles, CA
Author, Wide Awake and Dreaming: A Memoir of Narcolepsy
Julie Flygare, JD

Julie Flygare, JD, is a leading ambassador for narcolepsy and sleep, and a strong advocate for patient-centered research. She is an accomplished speaker, Stanford Medicine X ePatient Scholar, and the award-winning author of Wide Awake and Dreaming: A Memoir of Narcolepsy. As President & CEO of Project Sleep, Julie leads the organization’s patient-driven advocacy, awareness, and education programs. For over a decade, she has fostered a variety of successful collaborations including bringing together 29 patient advocacy organizations to co-lead World Narcolepsy Day and launching the Sleep Advocacy Forum to elevate the sleep community’s profile on the national policy stage. Julie has lectured at numerous professional meetings across the U.S. and keynoted conferences in Ireland, Italy, Sweden, Australia, and the United Kingdom. She has co-authored papers in peer-reviewed publications and authored a chapter in a narcolepsy clinical textbook. Julie received her BA from Brown University and her JD from Boston College Law School focusing on health law and rare disease drug development. Most recently, on March 20, 2022, she delivered a TEDx talk at San Diego State University to open people’s eyes to the importance of sleep health and sleep disorders.

Statement of Need

The diagnosis of narcolepsy can lead to the following question for providers—now what? Between available treatment options, individual patient circumstances, and cardiovascular (CV) comorbidities, it is critical that health care professionals (HCPs) consider and incorporate these factors in treatment decision-making. In determining treatment for narcolepsy, the patient’s quality of life (QoL), lifestyle, and social determinants of health (SDoH) should remain at the core of treatment considerations. Due to the sodium composition among current treatments for narcolepsy, HCPs should select a treatment plan that is appropriate based upon individual CV factors. Alongside CV comorbidities, dosing and titration strategies should also be considered during treatment decision-making.

The final episode of this CMEO BriefCase series on narcolepsy focuses on weighing different treatment plans and optimization, considering CV comorbidities, and individualizing care based on the patient’s QoL, lifestyle, and SDoH. This activity features a panel of experts in the field as well as capturing the patient perspective from the founder of Project Sleep, Julie Flygare.

Learning Objective

Initiate or, where appropriate, switch treatment plans for narcolepsy that consider CV comorbidities, dosing, and titration strategies.

Financial Support

This program is supported by an independent medical education grant from Jazz Pharmaceuticals.

Target Audience

Sleep specialists, primary care practitioners, pulmonologists, neurologists, psychiatrists, physician associates (PAs), nurse practitioners (NPs), nurses, and pharmacists

Credit Information

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Nurses (ANCC) 1.0

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Pharmacists (ACPE) 1.0

This application-based activity is approved for 1.0 contact hour (0.10 CEUs) of continuing pharmacy credit.
Activity UAN: JA0007185-0000-23-089-H01-P

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Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process.

Dr. Zee reports the following financial relationships:

Advisory Board: Eisai Inc.; Harmony Biosciences; and Jazz Pharmaceuticals, Inc.

Consultant: Eisai Inc.; Jazz Pharmaceuticals, Inc.; and Takeda Pharmaceuticals U.S.A., Inc.

Grants: Sleep Number Corporation and Vanda Pharmaceuticals

Dr. Karl Doghramji reports the following financial relationships:

Consultant: Axsome; Biogen; Eisai Inc.; Harmony Biosciences; Idorsia Pharmaceuticals Ltd; Imbrium Therapeutics; Inspire Pharmaceuticals, Inc.; Janssen Pharmaceuticals, Inc.; Jazz Pharmaceuticals, Inc.; and Purdue Pharma

Research Support: Inspire Pharmaceuticals, Inc.

Stock Shareholder (directly purchased): Merck & Co., Inc.

Dr. Paul Doghramji reports the following financial relationships:

Advisory Board: Bayer; Eisai Inc.; and Idorsia Pharmaceuticals Ltd

Speakers Bureau: AbbVie Inc.; Eisai Inc.; Idorsia Pharmaceuticals Ltd; and Merck & Co., Inc.

Stock Shareholder (directly purchased): CVS Health Corporation and Pfizer Inc.

Ms. Flygare reports the following financial relationships:

Consultant: Alkermes

Speakers Bureau: Harmony Biosciences (paid to give one presentation on patient perspective)

Disclosures were obtained from the following peer reviewer and CME Outfitters, LLC, staff, with no disclosures to report:

  • Shirley Michelle Franks, MSN, APRN, FNP-BC (peer reviewer)
  • Susan Perry (planning committee)
  • John Jones, PharmD (planning committee)
  • Susan H. Yarbrough, CHCP (planning committee)
  • Sandra Caballero, PharmD (planning committee)
  • Sharon Tordoff (planning committee)

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

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Choosing and Optimizing Therapy in Narcolepsy
Event Date: 10/04/2023