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31DROXIDOPA FOR ORTHOSTATIC HYPOTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction: This systematic review and meta-analysis aims to determine the efficacy and safety of droxidopa in the treatment of orthostatic hypotension (OH), following its recent approvals in the US. Methods: MEDLINE, EMBASE, PubMed, Cochrane Controlled Trials Register, Web of Science, ProQuest and the WHO Clinical Trials Registry were searched. Studies were included if they randomised adults with OH to droxidopa or to control, and outcomes related to symptoms, daily activity, blood pressure or adverse events. Data was extracted independently by two reviewers. Risk of bias was judged against the Cochrane risk of bias tool and quality of evidence measured using GRADE criteria. A fixed-effects model was used for pooled analysis. Results: Of 224 identified records, four studies met eligibility, with a pooled sample size of 494. Mean age was 67 years (range 18-92). Study duration was between one and eight weeks. Droxidopa was effective at reducing dizziness [mean difference -0.97 (95% confidence interval -1.51, -0.42)], overall symptoms [-0.52 (-0.98, -0.06)] and difficulty with activity [-0.86 (-1.34, -0.38)]. Droxidopa was also effective at improving standing systolic blood pressure [3.9 (0.1, 7.69)]. Rates of adverse events were similar between droxidopa and control groups, including supine hypertension [odds ratio 1.93 (0.87, 4.25)]. Conclusions: Droxidopa is safe and effective at reducing the symptoms associated with neurogenic OH. It results in a modest increase in standing BP without increasing the risk of supine hypertension. Registration: PROSPERO ID CRD42015024612