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Real-world droxidopa or midodrine treatment persistence in patients with neurogenic orthostatic hypotension or orthostatic hypotension.
Auton Neurosci. 2020 Feb 28; 225:102659.AN

Abstract

BACKGROUND

Neurogenic orthostatic hypotension (nOH) is a subtype of orthostatic hypotension (OH) observed in the presence of neuropathy and is associated with increased risk of falling, impaired function, and poor quality of life. Droxidopa and midodrine are approved in the United States to treat symptomatic nOH and OH in adults, respectively. In this study, we compared the treatment persistence of droxidopa and midodrine.

METHODS

A retrospective analysis of patients prescribed either droxidopa or midodrine was conducted using the Symphony Health Solutions database (Symphony Health Solutions, Phoenix, AZ, USA). Inclusion criteria were (1) a pharmacy insurance claim in at least 16 consecutive quarters from mid-2014 to 2018 and (2) an active prescription for droxidopa or midodrine of ≥30 days' duration during that period. Treatment persistence was defined as the time to the first break in drug coverage of ≥45 days and was capped at 365 days.

RESULTS

Data from 2305 patients who received droxidopa and 117,243 patients who received midodrine were included in this analysis. Median (95% CI) treatment persistence was significantly longer in the droxidopa cohort versus the midodrine cohort (303 [274-325] vs 172 [169-176] days; P < 0.001). After adjustment for confounding factors, patients using droxidopa monotherapy (i.e., without any concomitant midodrine and/or fludrocortisone use) were 16% more likely to be persistent at any time point than patients using midodrine (P < 0.001).

CONCLUSIONS

In this real-world data analysis, patients using droxidopa without concomitant medications for OH were more likely to remain on treatment than patients on midodrine.

Authors+Show Affiliations

Lundbeck, Deerfield, IL, USA. Electronic address: SKYM@lundbeck.com.Lundbeck, Deerfield, IL, USA. Electronic address: CSUL@lundbeck.com.Lundbeck, Deerfield, IL, USA. Electronic address: KJCK@lundbeck.com.Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada; Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: satish.raj@ucalgary.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32200263

Citation

Kymes, Steven M., et al. "Real-world Droxidopa or Midodrine Treatment Persistence in Patients With Neurogenic Orthostatic Hypotension or Orthostatic Hypotension." Autonomic Neuroscience : Basic & Clinical, vol. 225, 2020, p. 102659.
Kymes SM, Sullivan C, Jackson K, et al. Real-world droxidopa or midodrine treatment persistence in patients with neurogenic orthostatic hypotension or orthostatic hypotension. Auton Neurosci. 2020;225:102659.
Kymes, S. M., Sullivan, C., Jackson, K., & Raj, S. R. (2020). Real-world droxidopa or midodrine treatment persistence in patients with neurogenic orthostatic hypotension or orthostatic hypotension. Autonomic Neuroscience : Basic & Clinical, 225, 102659. https://doi.org/10.1016/j.autneu.2020.102659
Kymes SM, et al. Real-world Droxidopa or Midodrine Treatment Persistence in Patients With Neurogenic Orthostatic Hypotension or Orthostatic Hypotension. Auton Neurosci. 2020 Feb 28;225:102659. PubMed PMID: 32200263.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Real-world droxidopa or midodrine treatment persistence in patients with neurogenic orthostatic hypotension or orthostatic hypotension. AU - Kymes,Steven M, AU - Sullivan,Christine, AU - Jackson,Kenneth, AU - Raj,Satish R, Y1 - 2020/02/28/ PY - 2019/06/19/received PY - 2020/01/23/revised PY - 2020/02/27/accepted PY - 2020/3/23/pubmed PY - 2020/3/23/medline PY - 2020/3/23/entrez KW - Droxidopa KW - Medication persistence KW - Midodrine KW - Neurogenic orthostatic hypotension KW - Orthostatic hypotension KW - Retrospective analysis SP - 102659 EP - 102659 JF - Autonomic neuroscience : basic & clinical JO - Auton Neurosci VL - 225 N2 - BACKGROUND: Neurogenic orthostatic hypotension (nOH) is a subtype of orthostatic hypotension (OH) observed in the presence of neuropathy and is associated with increased risk of falling, impaired function, and poor quality of life. Droxidopa and midodrine are approved in the United States to treat symptomatic nOH and OH in adults, respectively. In this study, we compared the treatment persistence of droxidopa and midodrine. METHODS: A retrospective analysis of patients prescribed either droxidopa or midodrine was conducted using the Symphony Health Solutions database (Symphony Health Solutions, Phoenix, AZ, USA). Inclusion criteria were (1) a pharmacy insurance claim in at least 16 consecutive quarters from mid-2014 to 2018 and (2) an active prescription for droxidopa or midodrine of ≥30 days' duration during that period. Treatment persistence was defined as the time to the first break in drug coverage of ≥45 days and was capped at 365 days. RESULTS: Data from 2305 patients who received droxidopa and 117,243 patients who received midodrine were included in this analysis. Median (95% CI) treatment persistence was significantly longer in the droxidopa cohort versus the midodrine cohort (303 [274-325] vs 172 [169-176] days; P < 0.001). After adjustment for confounding factors, patients using droxidopa monotherapy (i.e., without any concomitant midodrine and/or fludrocortisone use) were 16% more likely to be persistent at any time point than patients using midodrine (P < 0.001). CONCLUSIONS: In this real-world data analysis, patients using droxidopa without concomitant medications for OH were more likely to remain on treatment than patients on midodrine. SN - 1872-7484 UR - https://www.unboundmedicine.com/medline/citation/32200263/Real-world_droxidopa_or_midodrine_treatment_persistence_in_patients_with_neurogenic_orthostatic_hypotension_or_orthostatic_hypotension L2 - https://linkinghub.elsevier.com/retrieve/pii/S1566-0702(19)30144-4 DB - PRIME DP - Unbound Medicine ER -
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