Faculty mentor/PI email address
pittonrissardo-jamir@cooperhealth.edu
Keywords
Droxidopa, orthostatic hypotension, orthostatic dizziness, Parkinson's disease, multiple system atrophy, parkinsonism
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Neurogenic orthostatic hypotension (nOH) causes disabling symptoms such as dizziness, impaired daily activities, and increased fall risk. Droxidopa is approved for symptomatic treatment, but individual trials have reported heterogeneous results across outcomes and populations. We aim to evaluate the efficacy of droxidopa on symptoms, functional impact, blood pressure, and safety outcomes in patients with nOH. Methods: We conducted a systematic review and meta‑analysis of randomized controlled trials comparing droxidopa with placebo in nOH. Continuous outcomes were pooled using random‑effects models with standardized mean difference (SMD) for symptom scales and mean difference (MD) for standing systolic blood pressure (SBP). Binary outcomes were pooled using random‑effects Mantel–Haenszel risk ratios (RR). Heterogeneity was assessed using I2 statistics. Results: Across four trials, droxidopa significantly improved dizziness (SMD −0.38; 95% CI −0.63 to −0.13; Z −3.01, p=0.003; I2=40%) and difficulty with activity (SMD −0.33; 95% CI −0.55 to −0.12; Z −3.07, p=0.002; I2=12%), with small‑to‑moderate effect sizes and low‑to‑moderate heterogeneity. Results in composite symptom scores were non-significant (SMD −0.31; 95% CI −0.62 to 0.01). There was no significant pooled increase in standing SBP (MD +2.25 mmHg; 95% CI −2.58 to 7.09). Droxidopa reduced the risk of falls (RR 0.51; 95% CI 0.29 to 0.92) but increased the risk of supine hypertension (RR 1.95; 95% CI 1.03 to 3.69). No significant subgroup differences were observed. Conclusion: Droxidopa provides clinically meaningful symptomatic and functional benefits in nOH and reduces falls, at the cost of increased risk of supine hypertension. Careful patient selection and monitoring are warranted.
Disciplines
Medical Pharmacology | Medicine and Health Sciences
Included in
Efficacy and Safety of Droxidopa for Neurogenic Orthostatic Hypotension: A Systematic Review and Meta‑analysis
Neurogenic orthostatic hypotension (nOH) causes disabling symptoms such as dizziness, impaired daily activities, and increased fall risk. Droxidopa is approved for symptomatic treatment, but individual trials have reported heterogeneous results across outcomes and populations. We aim to evaluate the efficacy of droxidopa on symptoms, functional impact, blood pressure, and safety outcomes in patients with nOH. Methods: We conducted a systematic review and meta‑analysis of randomized controlled trials comparing droxidopa with placebo in nOH. Continuous outcomes were pooled using random‑effects models with standardized mean difference (SMD) for symptom scales and mean difference (MD) for standing systolic blood pressure (SBP). Binary outcomes were pooled using random‑effects Mantel–Haenszel risk ratios (RR). Heterogeneity was assessed using I2 statistics. Results: Across four trials, droxidopa significantly improved dizziness (SMD −0.38; 95% CI −0.63 to −0.13; Z −3.01, p=0.003; I2=40%) and difficulty with activity (SMD −0.33; 95% CI −0.55 to −0.12; Z −3.07, p=0.002; I2=12%), with small‑to‑moderate effect sizes and low‑to‑moderate heterogeneity. Results in composite symptom scores were non-significant (SMD −0.31; 95% CI −0.62 to 0.01). There was no significant pooled increase in standing SBP (MD +2.25 mmHg; 95% CI −2.58 to 7.09). Droxidopa reduced the risk of falls (RR 0.51; 95% CI 0.29 to 0.92) but increased the risk of supine hypertension (RR 1.95; 95% CI 1.03 to 3.69). No significant subgroup differences were observed. Conclusion: Droxidopa provides clinically meaningful symptomatic and functional benefits in nOH and reduces falls, at the cost of increased risk of supine hypertension. Careful patient selection and monitoring are warranted.