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Droxidopa for neurogenic orthostatic hypotension
- Source :
- Neurology
- Publication Year :
- 2014
- Publisher :
- Lippincott Williams & Wilkins, 2014.
-
Abstract
- Objective: To determine whether droxidopa, an oral norepinephrine precursor, improves symptomatic neurogenic orthostatic hypotension (nOH). Methods: Patients with symptomatic nOH due to Parkinson disease, multiple system atrophy, pure autonomic failure, or nondiabetic autonomic neuropathy underwent open-label droxidopa dose optimization (100–600 mg 3 times daily), followed, in responders, by 7-day washout and then a 7-day double-blind trial of droxidopa vs placebo. Outcome measures included patient self-ratings on the Orthostatic Hypotension Questionnaire (OHQ), a validated, nOH-specific tool that assesses symptom severity and symptom impact on daily activities. Results: From randomization to endpoint (n = 162), improvement in mean OHQ composite score favored droxidopa over placebo by 0.90 units (p = 0.003). Improvement in OHQ symptom subscore favored droxidopa by 0.73 units (p = 0.010), with maximum change in “dizziness/lightheadedness.” Improvement in symptom-impact subscore favored droxidopa by 1.06 units (p = 0.003), with maximum change for “standing a long time.” Mean standing systolic blood pressure (BP) increased by 11.2 vs 3.9 mm Hg (p < 0.001), and mean supine systolic BP by 7.6 vs 0.8 mm Hg (p < 0.001). At endpoint, supine systolic BP >180 mm Hg was observed in 4.9% of droxidopa and 2.5% of placebo recipients. Adverse events reported in ≥3% of double-blind droxidopa recipients were headache (7.4%) and dizziness (3.7%). No patients discontinued double-blind treatment because of adverse events. Conclusions: In patients with symptomatic nOH, droxidopa improved symptoms and symptom impact on daily activities, with an associated increase in standing systolic BP, and was generally well tolerated. Classification of evidence: This study provides Class I evidence that in patients with symptomatic nOH who respond to open-label droxidopa, droxidopa improves subjective and objective manifestation of nOH at 7 days.
- Subjects :
- Male
Time Factors
Posture
Blood Pressure
Parkinson Disease
Middle Aged
Multiple System Atrophy
Autonomic Agents
Dizziness
Article
Hypotension, Orthostatic
Treatment Outcome
Autonomic Nervous System Diseases
Double-Blind Method
Droxidopa
Pure Autonomic Failure
Humans
Female
Nervous System Diseases
Aged
Subjects
Details
- Language :
- English
- ISSN :
- 1526632X and 00283878
- Volume :
- 83
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Neurology
- Accession number :
- edsair.pmid..........ac5cd8d950a52b8c86fda1f6bb17108c