The Efficacy And Safety Of Droxidopa In Neurogenic Orthostatic Hypotension: Systematic Review And Meta-Analysis

Neurogenic orthostatic hypotension (nOH) is a disabling disorder, which is associated with primary diagnoses including Parkinson’s disease (PD), pure autonomic failure (PAF) and multiple system atrophy (MSA). Neurogenic orthostatic hypotension results from failure of the autonomic nervous system to generate norepinephrine responses appropriate to postural challenge.Previous studies suggested that droxidopa could improve standing systolic blood pressure in nOH. Recently, droxidopa has been evaluated in several large, multicenter clinical trials (studies nOH301, nOH302, and nOH306), and those researches showed that droxidopa has both hemodynamic and symptomatic benefit in patients with symptomatic nOH. But there is no review to summarize the efficacy and safety of droxidopa. Therefore, we conducted a systematic review and meta-analysis to asses the efficacy, tolerability, and safety of droxidopa in the treatment of nOH.In the first week, OHQ composite score showed a statistically significant difference favoring droxidopa, and the result suggested that droxidopa could reduced nOH symptoms and nOH impact on daily activities. Droxidopa yielded statistically significant improvement, as assessed by an increaseing standing systolic BP (P=0.0003). But Hauser suggests that there is no significant different between both group when it comes to week 8. No significantly different in study termination due to adverse events was found between both group, and heterogeneity excisted.