Droxidopa Associated With Better Treatment Adherence Compared With Midodrine

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Droxidopa is associated with better treatment adherence than midodrine when medication cost is noninfluential.

The following article is part of conference coverage from the 2019 American Academy of Neurology Annual Meeting (AAN 2019) in Philadelphia, PA. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAN 2019.

PHILADELPHIA — Among those with orthostatic or neurogenic hypotension, droxidopa is associated with better treatment adherence compared with midodrine when medication cost is noninfluential. This research was presented at the 2019 American Academy of Neurology’s Annual Meeting, held May 4 to 10, 2019, in Philadelphia, Pennsylvania.

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This retrospective analysis included 688 individuals using droxidopa (mean age 63.8 years; 48% women) and 1888 using midodrine (mean age 55.2 years; 62% women) from the Symphony Health Solutions Database. All participants had continuous healthcare coverage between September 2014 and June 2017, filled a prescription for at least 1 month of either midodrine or droxidopa in that time period, and did not have a copay for their prescription. There was a 1-year cap on adherence. Multivariable Cox regression analysis and a log-rank test were used to calculate statistical variation between midodrine and droxidopa survival curves.

Droxidopa had a significantly longer median persistence than midodrine (240 days; 95% CI, 210-299 vs 180 days; 95% CI, 160-183; P <.0001). Those taking midodrine were 27.4% more likely to become nonadherent after adjustments for clinical and demographic factors (P =.002).

Diagnoses among participants in the midodrine and droxidopa treatment groups included cardiovascular disease (70%, 34% respectively), Parkinson disease (1%, 12% respectively), comorbid cardiovascular and Parkinson disease (3%, 18% respectively), and unknown (26%, 36% respectively).

The study researchers concluded that “[when] medication cost is not an influencing factor, patients using droxidopa were more likely to remain on treatment than patients on midodrine. The reason for this is unknown, but could be due to enhanced efficacy or fewer side effects.”

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Hewitt LA, Kymes S, Jackson K, Widolff M, Sullivan C, Raj SR. Droxidopa and midodrine treatment persistence in patients with orthostatic hypotension. Poster presented at: American Academy of Neurology Annual Meeting, May 4-10, 2019, Philadelphia, Pennsylvania. P3.6-047.