Droxidopa Effective as Adjunct Therapy for Vasopressor Weaning in ICU Patients, finds study

The study, published in the Journal of Intensive Care Medicine, suggested that droxidopa may be a valuable adjunct therapy for facilitating vasopressor weaning, with comparable effects observed in patients receiving the medication through feeding tubes.

Persistent hypotension is a significant challenge in the management of critically ill patients, often leading to prolonged reliance on vasopressor agents. These medications can have adverse effects and complications, underscoring the need for alternative strategies to facilitate safe withdrawal.

According to the study authors, persistent reliance on vasopressors is a frequent factor contributing to delays in patient discharge from the intensive care unit (ICU). They note that adjunct oral agents can accelerate the timeline for discontinuing vasopressor treatment. Considering this, Andrew J Webb, Department of Pharmacy, Massachusetts General Hospital, Boston, USA, and colleagues sought to examine the application of droxidopa for facilitating vasopressor weaning in critically ill patients experiencing prolonged hypotension.

For this purpose, this retrospective, single-arm observational study focused on adult patients admitted to ICUs at two academic centers between June 2016 and July 2023 who received droxidopa for vasopressor weaning. Patients who had received droxidopa before admission or for other indications were excluded from the analysis.

The primary outcome measured was the time to vasopressor discontinuation, defined as the duration for which vasopressors were stopped and remained off for at least 24 hours. Secondary outcomes included the rates of tachycardia and hypotension following the initiation of droxidopa, norepinephrine equivalents before and after treatment, concomitant use of oral agents, and dosing details. Additionally, a subgroup analysis was performed on patients receiving droxidopa via feeding tubes.

The following were the key findings of the study:

• A total of 30 patients met the inclusion criteria for the study. The median age was 62 years, with 12 patients being female, and 73% of participants were admitted to a cardiac or cardiac surgical ICU.
• Before the initiation of droxidopa, patients had been on vasopressors for a median of 16 days.
• The median time to vasopressor discontinuation was 70 hours, and norepinephrine equivalents showed a significant decrease immediately after droxidopa initiation (0.08 versus 0.02 mcg/kg/min).
• Mean arterial pressure (MAP) increased following the start of droxidopa (68.8 versus 66.5 mm Hg), while heart rates remained stable (86 versus 84 BPM).
• Patients who successfully weaned off vasopressors within 72 hours of initiating droxidopa had lower norepinephrine equivalents before treatment than those who took longer than 72 hours (0.05 versus 0.12 mcg/kg/min).
• The method of administration via feeding tubes did not significantly affect the time to vasopressor discontinuation.

"The findings indicate that droxidopa could serve as an effective adjunct therapy for vasopressor weaning in critically ill patients. Further prospective studies are needed to assess this intervention comprehensively," the researchers concluded.

Reference:

Webb, A. J., Casal, G. L., Newman, K. A., Culshaw, J. R., Northam, K. A., Solomon, E. J., Beargie, S. M., Johnson, R. B., Lopez, N. D., Hayes, B. D., & Roberts, R. J. (2024). Droxidopa for Vasopressor Weaning in Critically Ill Patients with Persistent Hypotension: A Multicenter, Retrospective, Single-Arm Observational Study. Journal of Intensive Care Medicine. https://doi.org/10.1177/08850666241270089