Effects of Atomoxetine for the Treatment of Neurogenic Orthostatic Hypotension in Patients With Alpha-synucleinopathies: A Systematic Review of Randomized Controlled Trials and a Focus-Group Discussion
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Background and Purpose Neurogenic orthostatic hypotension (nOH) is one of the most important nonmotor symptoms in patients with α-synucleinopathies. Atomoxetine is a selective norepinephrine transporter blocker that is a treatment option for nOH. This systematic review and expert focus-group study was designed to obtain evidence from published data and clinical experiences of Korean movement-disorder specialists about the efficacy and safety of atomoxetine for the pharmacological treatment of nOH in patients with α-synucleinopathies. Methods The study comprised a systematic review and a focus-group discussion with clinicians. For the systematic review, multiple comprehensive databases including MEDLINE, Embase, Cochrane Library, CINAHL, PsycInfo, and KoreaMed were searched to retrieve articles that assessed the outcomes of atomoxetine therapy. A focus-group discussion was additionally performed to solicit opinions from experts with experience in managing nOH. Results The literature review process yielded only four randomized controlled trials on atomoxetine matching the inclusion criteria. Atomoxetine effectively increased systolic blood pressure and improved OH-related symptoms as monotherapy or in combination with other drugs. Its effects were pronounced in cases with central autonomic failure, including multiple-system atrophy (MSA). Atomoxetine might be a safe monotherapy regarding the risk of supine hypertension. Conclusions Atomoxetine is an effective and safe option for short-term nOH management, which could be more evident in patients with central autonomic dysfunction such as MSA. However, there is a paucity of evidence in the literature, and data from the focus-group discussion were inadequate, and so further investigation is warranted.
Abstract
Background and Purpose Neurogenic orthostatic hypotension (nOH) is one of the most important nonmotor symptoms in patients with α-synucleinopathies. Atomoxetine is a selective norepinephrine transporter blocker that is a treatment option for nOH. This systematic review and expert focus-group study was designed to obtain evidence from published data and clinical experiences of Korean movement-disorder specialists about the efficacy and safety of atomoxetine for the pharmacological treatment of nOH in patients with α-synucleinopathies. Methods The study comprised a systematic review and a focus-group discussion with clinicians. For the systematic review, multiple comprehensive databases including MEDLINE, Embase, Cochrane Library, CINAHL, PsycInfo, and KoreaMed were searched to retrieve articles that assessed the outcomes of atomoxetine therapy. A focus-group discussion was additionally performed to solicit opinions from experts with experience in managing nOH. Results The literature review process yielded only four randomized controlled trials on atomoxetine matching the inclusion criteria. Atomoxetine effectively increased systolic blood pressure and improved OH-related symptoms as monotherapy or in combination with other drugs. Its effects were pronounced in cases with central autonomic failure, including multiple-system atrophy (MSA). Atomoxetine might be a safe monotherapy regarding the risk of supine hypertension. Conclusions Atomoxetine is an effective and safe option for short-term nOH management, which could be more evident in patients with central autonomic dysfunction such as MSA. However, there is a paucity of evidence in the literature, and data from the focus-group discussion were inadequate, and so further investigation is warranted.
참고문헌 (27)
- Freeman R, "Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome", Clin Auton Res, 21, pp.69~72 (2011)
- Robertson D, "The pathophysiology and diagnosis of orthostatic hypotension", Clin Auton Res, 18(Suppl 1), pp.2~7 (2008)
- Coon EA, "Neuropathology of autonomic dysfunction in synucleinopathies", Mov Disord, 33, pp.349~358 (2018)
- Seppi K, "Update on treatments for nonmotor symptoms of Parkinson’s disease-an evidence-based medicine review", Mov Disord, 34, pp.180~198 (2019)
- Cheshire WP, "Chemical pharmacotherapy for the treatment of orthostatic hypotension", Expert Opin Pharmacother, 20, pp.187~199 (2019)
- Adler LA, "Long-term, open-label safety and efficacy of atomoxetine in adults with ADHD : final report of a 4-year study", J Atten Disord, 12, pp.248~253 (2008)
- Shibao C, "Norepinephrine transporter blockade with atomoxetine induces hypertension in patients with impaired autonomic function", Hypertension, 50, pp.47~53 (2007)
- Ramirez CE, "Efficacy of atomoxetine versus midodrine for the treatment of orthostatic hypotension in autonomic failure", Hypertension, 64, pp.1235~1240 (2014)
- Okamoto LE, "Synergistic pressor effect of atomoxetine and pyridostigmine in patients with neurogenic orthostatic hypotension", Hypertension, 73, pp.235~241 (2019)
- Okamoto LE, "Synergistic effect of norepinephrine transporter blockade and α-2 antagonism on blood pressure in autonomic failure", Hypertension, 59, pp.650~656 (2012)
- Lei LY, "Pharmacological norepinephrine transporter inhibition for the prevention of vasovagal syncope in young and adult subjects : a systematic review and meta-analysis", Heart Rhythm, 17, pp.1151~1158 (2020)
- Nwazue VC, "Confounders of vasovagal syncope : orthostatic hypotension", Cardiol Clin, 31, pp.89~100 (2013)
- Moher D, "Preferred reporting items for systematic review and meta-analysis protocols(PRISMA-P)2015 statement", Syst Rev, 4, pp.1~ (2015)
- Chien PF, "Registration of systematic reviews : PROSPERO", BJOG, 119, pp.903~905 (2012)
- Kalra DK, "Neurogenic orthostatic hypotension : state of the art and therapeutic strategies", Clin Med Insights Cardiol, 14, pp.1179546820953415~ (2020)
- Higgins JP, "The Cochrane Collaboration's tool for assessing risk of bias in randomised trials", BMJ, 343, pp.d5928~ (2011)
- Francis JJ, "What is an adequate sample size? Operationalising data saturation for theory-based interview studies", Psychol Health, 25, pp.1229~1245 (2010)
- Braun V, "What can"thematic analysis"offer health and wellbeing researchers?", Int J Qual Stud Health Well-Being, 9, pp.26152~ (2014)
- Kaufmann H, "The orthostatic hypotension questionnaire(OHQ) : validation of a novel symptom assessment scale", Clin Auton Res, 22, pp.79~90 (2012)
- Kwon S, "Thirty years of national health insurance in South Korea : lessons for achieving universal health care coverage", Health Policy Plan, 24, pp.63~71 (2009)
- Sankanika Roy, "Cardiovagal Barorefex Sensitivity in Parkinson’s Disease and Multiple-System Atrophy", Journal of Clinical Neurology, 12(2), pp.218~223 (2016), 대한신경과학회[DOI]
- Biaggioni I, "The pharmacology of autonomic failure : from hypotension to hypertension", Pharmacol Rev, 69, pp.53~62 (2017)
- Shibao CA, "Predictors of the pressor response to the norepinephrine transporter inhibitor, atomoxetine, in neurogenic orthostatic hypotension", Hypertension, 78, pp.525~531 (2021)
- 김중석, "Cardiovascular Autonomic Dysfunction in Patients with Drug-Induced Parkinsonism", Journal of Clinical Neurology, 13(1), pp.15~20 (2017), 대한신경과학회[DOI]
- Palma JA, "Supine plasma NE predicts the pressor response to droxidopa in neurogenic orthostatic hypotension", Neurology, 91, pp.e1539~e1544 (2018)
- Phillip A. Low, "Orthostatic Hypotension: Mechanisms, Causes, Management", Journal of Clinical Neurology, 11(3), pp.220~226 (2015), 대한신경과학회[DOI]
- Biaggioni I, "Hypertension in orthostatic hypotension and autonomic dysfunction", Cardiol Clin, 20, pp.291~301 (2002)