Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension

Jung Ick Byun, Do Yong Kim, Jangsup Moon, Hye Rim Shin, Jun Sang Sunwoo, Woo Jin Lee, Han Sang Lee, Kyung Il Park, Soon Tae Lee, Keun Hwa Jung, Ki Young Jung, Manho Kim, Sang Kun Lee, Kon Chu

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)112-120
Number of pages9
JournalAnnals of Clinical and Translational Neurology
Volume7
Issue number1
DOIs
StatePublished - 1 Jan 2020

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Midodrine
Orthostatic Hypotension
Blood Pressure
Therapeutics
Atomoxetine Hydrochloride
Safety

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Byun, Jung Ick ; Kim, Do Yong ; Moon, Jangsup ; Shin, Hye Rim ; Sunwoo, Jun Sang ; Lee, Woo Jin ; Lee, Han Sang ; Park, Kyung Il ; Lee, Soon Tae ; Jung, Keun Hwa ; Jung, Ki Young ; Kim, Manho ; Lee, Sang Kun ; Chu, Kon. / Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension. In: Annals of Clinical and Translational Neurology. 2020 ; Vol. 7, No. 1. pp. 112-120.
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abstract = "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.",
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Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension. / Byun, Jung Ick; Kim, Do Yong; Moon, Jangsup; Shin, Hye Rim; Sunwoo, Jun Sang; Lee, Woo Jin; Lee, Han Sang; Park, Kyung Il; Lee, Soon Tae; Jung, Keun Hwa; Jung, Ki Young; Kim, Manho; Lee, Sang Kun; Chu, Kon.

In: Annals of Clinical and Translational Neurology, Vol. 7, No. 1, 01.01.2020, p. 112-120.

Research output: Contribution to journalArticle

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T1 - Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension

AU - Byun, Jung Ick

AU - Kim, Do Yong

AU - Moon, Jangsup

AU - Shin, Hye Rim

AU - Sunwoo, Jun Sang

AU - Lee, Woo Jin

AU - Lee, Han Sang

AU - Park, Kyung Il

AU - Lee, Soon Tae

AU - Jung, Keun Hwa

AU - Jung, Ki Young

AU - Kim, Manho

AU - Lee, Sang Kun

AU - Chu, Kon

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Y1 - 2020/1/1

N2 - 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.

AB - 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.

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