Key result
Both droxidopa and midodrine significantly increased standing systolic blood pressure (MD 6.2 and 17 mm Hg), but midodrine significantly increased supine hypertension risk (RR 5.1; 95% CrI 1.6-24).
Why the study?
Does droxidopa or midodrine improve standing systolic blood pressure and affect the risk of supine hypertension in patients with neurogenic orthostatic hypotension?
Meta-Analysis (n=783)
Does droxidopa or midodrine improve standing systolic blood pressure and affect the risk of supine hypertension in patients with neurogenic orthostatic hypotension?
Mean Difference: 6.2 (95% CI 2.4–10)
In patients with neurogenic orthostatic hypotension, midodrine increases standing systolic blood pressure to a greater extent than droxidopa but comes with a significantly increased risk of supine hypertension.
Midodrine yields greater standing SBP gains than droxidopa yet elevates supine hypertension risk; extends comparative efficacy-safety data for neurogenic orthostatic hypotension.
BACKGROUND: The comparative effects of droxidopa and midodrine on standing systolic blood pressure (sSBP) and risk of supine hypertension in patients with neurogenic orthostatic hypotension (NOH) are unknown. OBJECTIVE: To perform a Bayesian mixed-treatment comparison meta-analysis of droxidopa and midodrine in the treatment of NOH. METHODS: The PubMed, CENTRAL, and EMBASE databases were searched up to November 16, 2016. Study selection consisted of randomized trials comparing droxidopa or midodrine with placebo and reporting on changes in sSBP and supine hypertension events. Data were pooled to perform a comparison among interventions in a Bayesian fixed-effects model using vague priors and Markov chain Monte Carlo simulation with Gibbs sampling, calculating pooled mean changes in sSBP and risk ratios (RRs) for supine hypertension with associated 95% credible intervals (CrIs). RESULTS: Six studies (4 administering droxidopa and 2 administering midodrine) enrolling a total of 783 patients were included for analysis. The mean change from baseline in sSBP was significantly greater for both drugs when compared with placebo (droxidopa 6.2 mm Hg [95% CrI = 2.4-10] and midodrine 17 mm Hg [95% CrI = 11.4-23]). Comparative analysis revealed a significant credible difference between droxidopa and midodrine. The RR for supine hypertension was significantly greater for midodrine, but not droxidopa, when compared with placebo (droxidopa RR = 1.4 [95% CrI = 0.7-2.7] and midodrine RR = 5.1 [95% CrI = 1.6-24]). Conclusion and Relevance: In patients with NOH, both droxidopa and midodrine significantly increase sSBP, the latter to a greater extent. However, midodrine, but not droxidopa, significantly increases risk of supine hypertension.
No takes yet. Share an insight, caveat, or question.
Chen et al. (2018) conducted a meta-analysis in neurogenic orthostatic hypotension (n=783). Droxidopa and midodrine vs. Placebo was evaluated on mean change from baseline in standing systolic blood pressure (sSBP) for droxidopa vs placebo (MD 6.2 mm Hg, 95% CI 2.4-10). Both droxidopa and midodrine significantly increased standing systolic blood pressure (MD 6.2 and 17 mm Hg), but midodrine significantly increased supine hypertension risk (RR 5.1; 95% CrI 1.6-24).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: