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Efficacy and Safety of Midodrine and Atomoxetine for Neurogenic OH

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ClinicalTrials.gov Identifier: NCT03350659
Recruitment Status : Completed
First Posted : November 22, 2017
Last Update Posted : April 5, 2019
Sponsor:
Collaborator:
Kyung Hee University Hospital at Gangdong
Information provided by (Responsible Party):
Kon Chu, Seoul National University Hospital

Brief Summary:
This was a randomized, open-label clinical trial. We will enroll patients with symptomatic neurogenic OH and randomize them to 1 of 2 treatments: (1) midodrine only, (2) atomoxetine only. We will follow up patients at 1 and 3 months after treatment. If the patients meet BP criteria for OH at 1 month, they will receive combination treatment with both midodrine and atomoxetin. The primary outcome measure is amelioration of questionnaire score evaluating OH-associated symptoms at 3 months. Secondary end-points were improvement in orthostatic blood pressure (BP) drop at 1 and 3 months.

Condition or disease Intervention/treatment Phase
Neurogenic Orthostatic Hypotension Drug: Midodrine Drug: Atomoxetine Phase 4

Detailed Description:

Visit 1.

  1. Enroll, baseline evaluation of the patients
  2. Questionnaire

    • Evaluate orthostatic hypotension symptom: Orthostatic Hypotension Questionnaire (OHQ)
    • Quality of life: Korean version of Short-form 36
    • Depressive symptom: Korean version of Beck Depression Inventory(BDI)-2
  3. Blood test (6cc): ELISA for alpha 1,2 and beta 1,2 adrenergic receptor antibody and nicotinic acetylcholine receptor antibody. Preserve sample for genetic testing.
  4. Randomization: randomize patients to three group in 1:1 ratio (Midodrine 5mg/day single, Atomoxetine 18mg/day single)
  5. Treatment education Visit 2. 1 month after treatment Orthostatic BP check/ check drug compliance and side effect/ Questionnaire If the patients meet BP criteria for OH, initiate combination treatment (Midodrine 5mg/day+Atomoxetine 18mg/day) Visit 3. 3 months after treatment Orthostatic BP check/ check drug compliance and side effect/ Questionnaire

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 50 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Randomized, open-label clinical trial.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy and Safety of Midodrine and Atomoxetine Treatment in Patients With Neurogenic Orthostatic Hypotension : A Prospective Randomized Study
Actual Study Start Date : January 1, 2018
Actual Primary Completion Date : January 29, 2019
Actual Study Completion Date : March 15, 2019


Arm Intervention/treatment
Experimental: Atomoxetine
Atomoxetine 18mg once a day.
Drug: Atomoxetine
Atomoxetine single 18mg/day
Other Name: Atomoxetine only

Active Comparator: Midodrine
midodrine 2.5mg twice a day (increase to 5mg three times a day if necessary)
Drug: Midodrine
Midodrine single 5mg/day
Other Name: Midodrine only




Primary Outcome Measures :
  1. Change of the Orthostatic Hypotension Associated Symptom Questionnaire (OH Questionnaire (OHQ) [ Time Frame: after 3-month medical treatment ]

    Change of the OH associated symptom survey result after 3-month medical treatment compared to initial results. OHQ questionnaire has two components: the OH daily activity scale (OHDAS), which contains 4 items measuring the impact of OH on daily activities, and the OH symptom assessment (OHSA), which contains 6 items measuring the symptoms of OH (dizziness/light headedness, vision disturbance, weakness, fatigue, trouble concentrating, and head/neck discomfort).This questionnaire reflects the severity of OH-related symptoms on a 10-point scale, with 0 indicating the absence of a symptom and 10 indicating maximal severity.

    ** OHQ total score minimal 0 ~ maximal 100 (subscale OHDAS score minimal 0~ maximal 40, OHSA score minimal 0~ maximal 60)



Secondary Outcome Measures :
  1. Change in Orthostatic blood pressure Drop (mmHg) [ Time Frame: after 3-month medical treatment ]
    Change of orthostatic Systolic blood pressure and Diastolic Blood Pressure drop after 3-month medical treatment compared to initial results.

  2. Change of the Depression Score (Beck Depression Inventory-II ) [ Time Frame: after 3-month medical treatment ]

    Change of the depression score after 3-month medical treatment compared to initial results.

    21 multiple-choice questions, each of which can be scored from 0 to 3. Higher score represent higher degree of depression. Score Normal; 0-13, Mild depression; 14-19, Moderate depression; 20-28, Severe depression; 29- 63


  3. Changes in Health-related Quality of Life [ Time Frame: after 3-month medical treatment ]
    changes in Short Form (36) Health Survey version 2 (SF-36v2) physical component summary scale (PCS) compared to the baseline SF-36v2 measures eight HRQOL domains (physical functioning, role limitation caused by physical problems, bodily pain, general health, vitality, social functioning, role limitation caused by emotional problems, and mental health) summarized into two summary scales that are normalized to the population (mean=50, standard deviation=10): the physical component summary scale (PCS) and the mental component summary scale (MCS).20 Better HRQOL is reflected by higher SF-36v2 scores.



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Ages Eligible for Study:   19 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age >=19 patients who complained of dizziness
  • Orthostatic hypotension after 3-minute standing (systolic blood pressure drop >=20 or diastolic blood pressure drop >=10

Exclusion Criteria:

  • Drug-induced hypotension, if necessary, evaluate patient after discontinuing the causative drug for one month
  • Heart failure or Chronic renal failure
  • Severe supine hypertension (Systolic Blood Pressure >180 or Diastolic Blood Pressure>110mmHg)
  • Pregnant women, breast-feeding
  • Unable to perform questionnaire

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03350659


Locations
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Korea, Republic of
Seoul National University Hospital
Seoul, Korea, Republic of, 03080
Sponsors and Collaborators
Seoul National University Hospital
Kyung Hee University Hospital at Gangdong
Investigators
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Principal Investigator: Chu Kon Seoul National University Hospital

Publications:

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Responsible Party: Kon Chu, Professor, Seoul National University Hospital
ClinicalTrials.gov Identifier: NCT03350659     History of Changes
Other Study ID Numbers: 1710-060-893
First Posted: November 22, 2017    Key Record Dates
Last Update Posted: April 5, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by Kon Chu, Seoul National University Hospital:
orthostatic hypotension
midodrine
atomoxetine
treatment

Additional relevant MeSH terms:
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Hypotension
Hypotension, Orthostatic
Vascular Diseases
Cardiovascular Diseases
Orthostatic Intolerance
Primary Dysautonomias
Autonomic Nervous System Diseases
Nervous System Diseases
Atomoxetine Hydrochloride
Midodrine
Adrenergic Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Adrenergic Agents
Neurotransmitter Agents
Physiological Effects of Drugs
Sympathomimetics
Autonomic Agents
Peripheral Nervous System Agents
Vasoconstrictor Agents
Adrenergic alpha-1 Receptor Agonists
Adrenergic alpha-Agonists
Adrenergic Agonists