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Tytuł:
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Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension.
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Autorzy:
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Byun JI; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
Kim DY; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
Moon J; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.; Rare Disease Center, Seoul National University Hospital, Seoul, Republic of Korea.
Shin HR; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
Sunwoo JS; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
Lee WJ; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
Lee HS; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
Park KI; Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea.
Lee ST; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jung KH; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jung KY; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
Kim M; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
Lee SK; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
Chu K; Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Źródło:
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Annals of clinical and translational neurology [Ann Clin Transl Neurol] 2020 Jan; Vol. 7 (1), pp. 112-120. Date of Electronic Publication: 2019 Dec 19.
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Typ publikacji:
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Comparative Study; Journal Article; Randomized Controlled Trial
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Język:
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English
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Imprint Name(s):
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Original Publication: [Hoboken, NJ] : Wiley Periodicals, Inc on behalf of American Neurological Association, [2014]-
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MeSH Terms:
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Adrenergic Uptake Inhibitors/*pharmacology
Adrenergic alpha-1 Receptor Agonists/*pharmacology
Atomoxetine Hydrochloride/*pharmacology
Hypotension, Orthostatic/*drug therapy
Midodrine/*pharmacology
Adrenergic Uptake Inhibitors/administration & dosage ; Adrenergic Uptake Inhibitors/adverse effects ; Adrenergic alpha-1 Receptor Agonists/administration & dosage ; Adrenergic alpha-1 Receptor Agonists/adverse effects ; Aged ; Atomoxetine Hydrochloride/administration & dosage ; Atomoxetine Hydrochloride/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Midodrine/administration & dosage ; Midodrine/adverse effects ; Outcome Assessment, Health Care ; Prospective Studies
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References:
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Substance Nomenclature:
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0 (Adrenergic Uptake Inhibitors)
0 (Adrenergic alpha-1 Receptor Agonists)
57WVB6I2W0 (Atomoxetine Hydrochloride)
6YE7PBM15H (Midodrine)
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Entry Date(s):
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Date Created: 20191220 Date Completed: 20210201 Latest Revision: 20210201
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Update Code:
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20240105
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PubMed Central ID:
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PMC6952305
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DOI:
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10.1002/acn3.50968
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PMID:
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31856425
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Objective: The efficacy and safety of 1-month atomoxetine and midodrine therapies were compared. Three-month atomoxetine and combination therapies were investigated for additional benefits.
Methods: This prospective open-label randomized trial included 50 patients with symptomatic neurogenic orthostatic hypotension (nOH). The patients received either atomoxetine 18 mg daily or midodrine 5 mg twice daily and were evaluated 1 and 3 months later. Those who still met the criteria for nOH at 1 month received both midodrine and atomoxetine for an additional 2 months, and if not, they continued their initial medication. The primary outcome was an improvement in orthostatic blood pressure (BP) drop (maximum BP change from supine to 3 min after standing) at 1 month. The secondary endpoints were symptom scores, percentage of patients with nOH at 1 and 3 months.
Results: Patients with midodrine or atomoxetine treatment showed comparative improvement in the orthostatic BP drop, and overall only 26.2% of the patients had nOH at 1 month, which was similar between the treatment groups. Only atomoxetine resulted in significant symptomatic improvements at 1 month. For those without nOH at 1 month, there was additional symptomatic improvement at 3 months with their initial medication. For those with nOH at 1 month, the combination treatment resulted in no additional improvement. Mild-to-moderate adverse events were reported by 11.6% of the patients.
Interpretation: One-month atomoxetine treatment was effective and safe in nOH patients. Atomoxetine improved orthostatic BP changes as much as midodrine and was better in terms of ameliorating nOH symptoms.
(© 2019 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association.)
Erratum in: Ann Clin Transl Neurol. 2020 Mar;7(3):402. (PMID: 32202069)
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