Kymes Steven M, Sullivan Christine, Jackson Kenneth, Raj Satish R
Lundbeck, Deerfield, IL, USA.
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.
Auton Neurosci. 2020 May;225:102659. doi: 10.1016/j.autneu.2020.102659. Epub 2020 Feb 28.
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.
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.
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).
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.
神经源性直立性低血压（nOH）是在存在神经病变时观察到的直立性低血压（OH）的一种亚型，与跌倒风险增加、功能受损及生活质量差相关。在美国，屈昔多巴和米多君分别被批准用于治疗成人有症状的nOH和OH。在本研究中，我们比较了屈昔多巴和米多君的治疗持续性。
使用Symphony Health Solutions数据库（美国亚利桑那州凤凰城的Symphony Health Solutions）对开具屈昔多巴或米多君处方的患者进行回顾性分析。纳入标准为：（1）2014年年中至2018年期间至少连续16个季度有药房保险理赔记录；（2）在此期间有持续≥30天的屈昔多巴或米多君有效处方。治疗持续性定义为药物覆盖首次中断≥45天的时间，上限为365天。
本分析纳入了2305例接受屈昔多巴治疗的患者和117243例接受米多君治疗的患者的数据。屈昔多巴队列的中位（95%CI）治疗持续性显著长于米多君队列（303[274 - 325]天对172[169 - 176]天；P<0.001）。在对混杂因素进行调整后，使用屈昔多巴单药治疗（即未同时使用任何米多君和/或氟氢可的松）的患者在任何时间点持续治疗的可能性比使用米多君的患者高16%（P<0.001）。
在这项真实世界数据分析中，未同时使用治疗OH药物的屈昔多巴治疗患者比米多君治疗患者更有可能持续接受治疗。
