Objective: To determine if droxidopa improves gait speed, kyphosis, and functional reach in Parkinson’s disease when added to routine care treatment.

Background: Fall risk factors specific to Parkinson’s disease (PD) include kyphosis, postural instability, freezing of gait, dyskinesias, medication side effects, and decreased ability to react automatically to a loss of balance. Gait impairment in PD exists despite the use of dopinergic therapy. Postural instability and ambulatory dysfunction may be influenced by non-dopinergic pathology, particularly norepinephrine. Droxidopa is believed to exert its pharmacological effects through norepinephrine which increases blood pressure by inducing peripheral arterial and venous vasoconstriction.

Methods: A prospective, double-blind, randomized, placebo-controlled study was conducted in individuals with Parkinson’s disease on a stable dose of current PD medications. Key exclusionary criteria were hypertension and concomitant use of anti-hypertensive medications. Subjects were administered a 10 meter walk test, dual task timed up and go, thoracic flexi-curve measurement, and forward functional reach test at baseline and weeks 4, 8, and 12.

Results: Twenty-one subjects (62% male, 86% white) were randomized in a 2:1 fashion to either droxidopa or placebo. Mean age was 67.33 years (range 48 to 84 years). The starting dose of droxidopa was 100 mg TID and subjects were titrated every 48 hours until 600 mg TID or intolerability. There were no statistically significant improvements in 10-meter walk test, dual task timed up and go, forward functional reach test, or kyphotic posturing. There was a strong placebo effect among subjects. The most common adverse events were: weakness, urinary tract infection, fatigue, and increased freezing or shuffling of gait.

Conclusions: Droxidopa was generally well-tolerated without evidence of supine hypertension or serious adverse events. The results did not indicate droxidopa improved gait speed, dual task timed up and go, posture, or functional reach in Parkinson’s disease, however, further research beyond 12 weeks may be beneficial.

References: Allen, N.E., Schwarzel, A.K., & Canning, C.G. (2013). Recurrent falls in Parkinson’s disease: A systematic review. Parkinson’s disease, volume 2013. Doi: 10.115/2013/906274. Combs, S.A., Diehl, M.D., Filip, J., & Long, E. (2014(. Short-distance walking speed tests in people with Parkinson’s disease: reliability, responsiveness, and validity. Gait Posture, 39(2): 784-8.

« Back to 2018 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-droxidopa-when-measuring-gait-speed-kyphosis-and-functional-reach-in-parkinsons-disease/