Exposure of multiple system atrophy (MSA) patients with or without orthostatic hypotension (OH) to potentially hypotensive drugs

SANTIAGO P¨¦REZ LLORET; MARIA VER¨®NICA REY; PAVY A; W. MEISSNER; F. ORY-MAGNE; C. BREFEL-COURBON; N. FABRE; F. TISON; O. RASCOL

Congreso; 16th International Congress of Parkinson¡¯s Disease and Movement Disorders; 2012

Objective: To assess the exposure of MSA patients with or without OH to drugs that can potentially induce OH.To assess the exposure of MSA patients with or without OH to drugs that can potentially induce OH. Background: OH is a hallmark of MSA.OH is a hallmark of MSA. Methods: Patients were assessed at the French MSA reference Centers. The following variables were collectedPatients were assessed at the French MSA reference Centers. The following variables were collected severity (UMSARS II), clinical subtype and medication use. Blood pressure (BP) was measured 5 min after lying down and every min during 10 min after standing up. According to Gilman´s criteria, OH was defined as systolic/diastolic BP fall ¡Ý 30/15 mmHg during the first 3 min after standing. Exposure to drugs commonly associated with OH, such as insulin, antihypertensives of any class, peripheral vasodilators, drugs used for heart-disease treatment (including antiarrhytmics) alpha1-adrenergic receptor antagonists, levodopa, dopamine agonists, monoaminooxidase-B or catechol-o-methyl transferase inhibitors and antidepressants of any class, was recorded. Data was analyzed by chi-square test followed by logistic regression. associated with OH, such as insulin, antihypertensives of any class, peripheral vasodilators, drugs used for heart-disease treatment (including antiarrhytmics) alpha1-adrenergic receptor antagonists, levodopa, dopamine agonists, monoaminooxidase-B or catechol-o-methyl transferase inhibitors and antidepressants of any class, was recorded. Data was analyzed by chi-square test followed by logistic regression. ¡Ý 30/15 mmHg during the first 3 min after standing. Exposure to drugs commonly associated with OH, such as insulin, antihypertensives of any class, peripheral vasodilators, drugs used for heart-disease treatment (including antiarrhytmics) alpha1-adrenergic receptor antagonists, levodopa, dopamine agonists, monoaminooxidase-B or catechol-o-methyl transferase inhibitors and antidepressants of any class, was recorded. Data was analyzed by chi-square test followed by logistic regression. Results: 141 MSA patients were included in the study, but only 131 provided complete data (age 64.7¡À0.7, 50% males, 61% MSA-P, 83% MSA ¡°probable¡±, UMSARS II score 25.3¡À0.7, disease duration 5.0¡À0.2). OH was detected in 76 (58%) patients. Eighty-four percent of patients were exposed to at least 1 potentially hypotensive drug. These patients were exposed to a mean of 2 ¡À1 potentially hypotensive drugs. Patients with OH were less frequently exposed to antihypertensives (16% vs 31%, OR [95%CI]= 0.38 [0.16-0.92], p<0.01), levodopa (58% vs 78%, OR= 0.38 [0.17-0.84], p<0.01) or dopamine agonists (9% vs 36%, OR= 0.18 [0.07- 0.46]). Results remained significant after adjusting for demographic or disease-related factors by logistic regression analysis. 50% males, 61% MSA-P, 83% MSA ¡°probable¡±, UMSARS II score 25.3¡À0.7, disease duration 5.0¡À0.2). OH was detected in 76 (58%) patients. Eighty-four percent of patients were exposed to at least 1 potentially hypotensive drug. These patients were exposed to a mean of 2 ¡À1 potentially hypotensive drugs. Patients with OH were less frequently exposed to antihypertensives (16% vs 31%, OR [95%CI]= 0.38 [0.16-0.92], p<0.01), levodopa (58% vs 78%, OR= 0.38 [0.17-0.84], p<0.01) or dopamine agonists (9% vs 36%, OR= 0.18 [0.07- 0.46]). Results remained significant after adjusting for demographic or disease-related factors by logistic regression analysis. 141 MSA patients were included in the study, but only 131 provided complete data (age 64.7¡À0.7, 50% males, 61% MSA-P, 83% MSA ¡°probable¡±, UMSARS II score 25.3¡À0.7, disease duration 5.0¡À0.2). OH was detected in 76 (58%) patients. Eighty-four percent of patients were exposed to at least 1 potentially hypotensive drug. These patients were exposed to a mean of 2 ¡À1 potentially hypotensive drugs. Patients with OH were less frequently exposed to antihypertensives (16% vs 31%, OR [95%CI]= 0.38 [0.16-0.92], p<0.01), levodopa (58% vs 78%, OR= 0.38 [0.17-0.84], p<0.01) or dopamine agonists (9% vs 36%, OR= 0.18 [0.07- 0.46]). Results remained significant after adjusting for demographic or disease-related factors by logistic regression analysis. Conclusions: Our study showed that patients with OH were less frequently exposed to antihypertensives, levodopa or dopamine agonists. As it is possible that treating physicians may have avoided exposing MSA patients to these drugs, it this suggested that drug exposure may not be a major factor connected with OH in MSA. levodopa or dopamine agonists. As it is possible that treating physicians may have avoided exposing MSA patients to these drugs, it this suggested that drug exposure may not be a major factor connected with OH in MSA. Our study showed that patients with OH were less frequently exposed to antihypertensives, levodopa or dopamine agonists. As it is possible that treating physicians may have avoided exposing MSA patients to these drugs, it this suggested that drug exposure may not be a major factor connected with OH in MSA.