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Nitti VW, Kohan A, McCammon K, Jenkins B, Ifantides KB, Yushmanova I, Chapple C. Efficacy and safety of onabotulinumtoxinA for the treatment of overactive bladder in men and women: A pooled analysis. Neurourol Urodyn 2024. [PMID: 38973548 DOI: 10.1002/nau.25538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND This pooled analysis of randomized controlled studies investigated the safety and efficacy of onabotulinumtoxinA in male and female patients with overactive bladder (OAB). METHODS Data were pooled from four similarly designed trials in North America and Europe. Adults with idiopathic OAB for ≥6 months inadequately managed by at least one anticholinergic were randomized 1:1 or 2:1 to receive onabotulinumtoxinA 100 U or matched placebo in Cycle 1 and could request open-label retreatment with onabotulinumtoxinA 100 U at ≥12 weeks. Efficacy outcomes at Week 12 included the primary endpoint of mean urinary incontinence (UI) episodes per day and other variables, such as the proportion of patients with ≥50% reduction in daily UI episodes. Safety was assessed by monitoring treatment-emergent adverse events (TEAEs). Analyses by sex were descriptive. Males were further analyzed by benign prostatic hyperplasia (BPH) diagnosis status. RESULTS In the pooled population (N = 1564), there were 194 males (12.4%) and 1370 females (87.6%). Mean number of baseline UI episodes per day was 4.9 in males and 5.5 in females. At Week 12, numerically greater mean reductions from baseline in number of daily UI episodes were observed with the onabotulinumtoxinA 100 U group (females: -3.0; males: -2.2) versus placebo (females: -1.1; males: -1.3). Achievement of ≥50% reduction in daily UI episodes was numerically greater with onabotulinumtoxinA 100 U (females: 64.8%; males: 61.2%) versus placebo (females: 30.6%; males: 44.8%), and numerically higher in males without BPH (onabotulinumtoxinA: 65.1%; placebo: 50.9%) versus with BPH (onabotulinumtoxinA: 54.3%; placebo: 36.6%). A total of 34.7% of males and 39.4% of females experienced at least one TEAE in the first 12 weeks during treatment Cycle 1. Urinary tract infection rate was 13.1% in females and 4.2% in males; incidence of hematuria was 6.8% in males and 1.1% in females. Incidence of urinary retention (defined as incomplete emptying, requiring catheterization) was 2.7% in females and 4.7% in males. CONCLUSION OnabotulinumtoxinA 100 U was efficacious and well tolerated in men and women with OAB, including in males with and without BPH. No new safety findings were identified when data were analyzed by sex.
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Affiliation(s)
- Victor W Nitti
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alfred Kohan
- Advanced Urology Center of New York, New York, New York, USA
| | - Kurt McCammon
- Eastern Virginia Medical School, Norfolk, Virginia, USA
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Bowman M, Vélez CA, Jericevic D, Shapiro K, Mbassa R, Fang R, Brucker BM, Van Kuiken M. Factors Influencing Medication Selection for Management of Overactive Bladder: Trends and Insights From AUA Quality Registry. Urology 2024; 184:51-57. [PMID: 38081481 DOI: 10.1016/j.urology.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To determine how a patient's demographics, including insurance type, race/ethnicity, gender, and age, may impact the choice of medication prescribed for overactive bladder (OAB). METHODS We queried the AUA Quality Registry for adults between 2014 and 2020 with a diagnosis of OAB for >1year, excluding neurogenic causes. Variables included age, race/ethnicity, gender, insurance type, medication first prescribed, year of prescription, provider metropolitan status, and provider practice type. Primary outcome was which factors were associated with increased odds of beta-3 prescription as first medication choice. RESULTS We found 1,453,566 patients with OAB, 641,122 (44.1%) with complete data. Of these, 112,021 (17.5%) were prescribed medication. On multivariate analysis, patients with Medicaid, Medicare, and other/self-pay insurance were less likely to receive a beta-3 vs an anticholinergic compared to private or military insurance. Compared to white patients, Asian, Black, and other races were less likely to receive a beta-3, as were patients outside of metropolitan areas. Age >50, prescriptions after 2014, and nonacademic settings were associated with increased odds of beta-3 prescription. There was no difference between genders. CONCLUSION Many nonclinical factors, including insurance type and race, may affect which medication is first prescribed for OAB. This is useful for practicing urologists and may help lower barriers to beta-3 prescription through policy change and advocacy.
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Affiliation(s)
- Max Bowman
- University of California San Francisco, Department of Urology, San Francisco, CA.
| | - Camille A Vélez
- Universidad Central del Caribe, School of Medicine, Bayamon, PR
| | - Dora Jericevic
- New York University Langone, Department of Urology, New York, NY
| | | | | | | | | | - Michelle Van Kuiken
- University of California San Francisco, Department of Urology, San Francisco, CA
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Mama ST, Chandra Regmi M. Pelvic Floor Disorders/Obstetric Fistula. Obstet Gynecol Clin North Am 2022; 49:735-749. [DOI: 10.1016/j.ogc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leonardo K, Seno DH, Mirza H, Afriansyah A. Biofeedback-assisted pelvic floor muscle training and pelvic electrical stimulation in women with overactive bladder: A systematic review and meta-analysis of randomized controlled trials. Neurourol Urodyn 2022; 41:1258-1269. [PMID: 35686543 DOI: 10.1002/nau.24984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/16/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This meta-analysis aims to compare biofeedback-assisted pelvic muscle floor training (PFMT) and pelvic electrical stimulation (ES) as an intervention group, with PFMT or bladder training (BT) as the control group, in women with an overactive bladder (OAB). METHOD PubMed, Cochrane, CINAHL, EMBASE, and Scopus were systematically searched for randomized controlled trials (RCTs) published up to November 2021. The RCTs were screened for our eligibility criteria and quality was evaluated using the Cochrane Risk Index of Bias tools. The outcomes were changes in quality of life (QoL), episodes of incontinence, and the number of participants cured/improved. RESULTS Eight studies involving 562 patients (comprising 204 patients with biofeedback-assisted PFMT, 108 patients with pelvic ES, and 250 patients who received PFMT alone or BT and lifestyle recommendations only, as the control group) were included. The ES group showed significant differences in terms of changes to QoL (mean difference [MD]: 7.41, 95% confidence interval [CI]: 7.90-12.92, p = 0.008), episodes of incontinence (MD: -1.33, 95% CI: -2.50 to -0.17, p = 0.02), and the number of participants cured or improved (risk ratio [RR]: 1.46, 95% CI: 1.14-1.87, p = 0.003), while the biofeedback group resulted in nonsignificant changes in QoL (MD: 0.13, 95% CI: 7.87-8.12, p = 0.98), episodes of incontinence (MD: 0.01, 95% CI: -0.89 to 0.90, p = 0.99), and the number of participants cured or improved (RR: 1.15, 95% CI: 0.99-1.33, p = 0.08), both compared to the control group respectively. CONCLUSION This meta-analysis shows that low-frequency pelvic ES appears to be sufficient and effective as an additional intervention for women with OAB in clinical practice according to improvements in the subjects' QoL and reduction of symptoms. Meanwhile, biofeedback-assisted PFMT does not appear to be a significant adjuvant for conservative OAB therapy.
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Affiliation(s)
- Kevin Leonardo
- Department of Surgery, Division of Urology, Persahabatan General Hospital, Jakarta, Indonesia
| | - Doddy Hami Seno
- Department of Surgery, Division of Urology, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hendy Mirza
- Department of Surgery, Division of Urology, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Andika Afriansyah
- Department of Surgery, Division of Urology, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Linder JA, Weissman JS, Reyes Nieva H, Lipsitz S, Haring RS, DeAngelis J, Kristy RM, Loughlin KR. Overactive bladder in an integrated delivery system: a longitudinal cohort study. BMC Health Serv Res 2020; 20:447. [PMID: 32434511 PMCID: PMC7238545 DOI: 10.1186/s12913-020-05315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overactive bladder (OAB) is common and morbid. Medication and diagnosis claims may be specific, but lack sensitivity to identify patients with overactive bladder. We used an "electronic health record (EHR) phenotype" to identify cases and describe treatment choices and anticholinergic burden for OAB. METHODS We conducted a retrospective cohort study in a large, integrated health delivery system between July 2011 and June 2012 (2-year follow-up). We examined care from primary care and specialty clinics, medication and procedure use, and anticholinergic burden for each patient. RESULTS There were 7362 patients with an EHR OAB phenotype; 50% of patients were > 65 years old, 74% were female, and 83% were white. The distribution of care included primary care physician (PCP)/specialty co-management (25% of patients); PCP care only (18%); urology only (13%); or some other combination of specialty care (33%). Only 40% of patients were prescribed at least 1 OAB medication during the study. The mean duration of prescribed medication was 1.5 months (95% confidence interval [CI], 1.4 to 1.6 months; range, < 1 month to 24 months). Independent predictors of receipt of an OAB medication included increasing age (odds ratio [OR], 1.4 for every 10 years; 95% CI, 1.4 to 1.5), women (OR, 1.6 compared with men; 95% CI, 1.4 to 1.8), diabetes (OR, 1.3; 95% CI, 1.1 to 1.5), and certain sources of care compared with PCP-only care: PCP/specialty co-management (OR, 1.8; 95% CI, 1.5 to 2.0), urology (OR, 2.2; 95% CI, 1.8 to 2.6), and multiple specialists (OR, 1.4; 95% CI, 1.2 to 1.8). Very few patients received other treatments: biofeedback (< 1%), onabotulinumtoxinA (2%), or sacral nerve stimulation (1%). Patients who received OAB medications had significantly higher anticholinergic burden than patients who did not (anticholinergic total standardized daily dose, 125 versus 46; P < .001). CONCLUSIONS Although OAB is common and morbid, in a longitudinal study using an EHR OAB phenotype 40% of patients were treated with OAB medication and only briefly.
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Affiliation(s)
- Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Harry Reyes Nieva
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Sterling Haring
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Rita M Kristy
- Astellas Pharma Global Development, Northbrook, IL, USA
| | - Kevin R Loughlin
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Burnett AL, Walker DR, Feng Q, Johnston KM, Lozano-Ortega G, Nimke D, Hairston JC. Undertreatment of overactive bladder among men with lower urinary tract symptoms in the United States: A retrospective observational study. Neurourol Urodyn 2020; 39:1378-1386. [PMID: 32383533 PMCID: PMC7384148 DOI: 10.1002/nau.24348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/21/2020] [Indexed: 01/18/2023]
Abstract
Aims To characterize the epidemiology and treatment patterns of adult men (≥40 years) diagnosed with, or treated for, overactive bladder (OAB) and/or benign prostatic hyperplasia (BPH). Methods This retrospective observational study used data extracted from the IBM MarketScan Commercial Claims and Encounters database and the Medicare Supplemental Coordination of Benefits database. Men with BPH and/or OAB were identified and observed to assess treatment and diagnostic patterns. Results Within the entire study sample (N = 462 400), BPH diagnosis (61.5%) and BPH treatment (73.7%) were more common than the corresponding values for OAB (25.8% and 7.0%, respectively). Notably, among diagnosed individuals, the dispensation of a corresponding treatment was more likely in individuals diagnosed with BPH (183 672 out of 284 416 = 64.6%) compared with OAB (16 468 out of 119 236 = 13.8%). Among newly diagnosed and/or treated patients (n = 196 576), only 60.3% received treatment. Among treated patients, most experienced only a single type of treatment (93.4%), 6.6% went on to receive a secondary treatment and 3.5% a tertiary. The most common primary treatment was alpha‐blocker monotherapy (76.9%) followed by tadalafil monotherapy (16.4%). Among those untreated at first diagnosis, the median time between diagnosis and treatment initiation was 128 days. Conclusions Diagnosis and management of OAB among males are challenging given the inherent overlap in symptoms observed with BPH. Unsurprisingly, we found that BPH is diagnosed and treated more frequently than OAB; but the differences between diagnosis and treatment patterns for the two conditions highlight the potential undertreatment of OAB and misdirection of therapy for men with a combination of voiding and storage symptoms.
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Affiliation(s)
- Arthur L Burnett
- Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David R Walker
- Department of Urology, Astellas Pharma Global Development Inc, Northbrook, Illinois
| | - Qi Feng
- Department of Urology, Astellas US LLC, Northbrook, Illinois
| | - Karissa M Johnston
- Department of Urology, Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada
| | - Greta Lozano-Ortega
- Department of Urology, Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada
| | - David Nimke
- Department of Urology, Astellas US LLC, Northbrook, Illinois
| | - John C Hairston
- Department of Urology, Astellas Pharma Global Development Inc, Northbrook, Illinois
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Parise H, Espinosa R, Dea K, Anaya P, Montoya G, Ng DB. Cost Effectiveness of Mirabegron Compared with Antimuscarinic Agents for the Treatment of Adults with Overactive Bladder in Colombia. PHARMACOECONOMICS - OPEN 2020; 4:79-90. [PMID: 31168754 PMCID: PMC7018934 DOI: 10.1007/s41669-019-0149-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the cost effectiveness of mirabegron relative to two antimuscarinics, oxybutynin extended release (ER) and tolterodine ER, in patients with overactive bladder (OAB) from the perspective of a third-party payer in Colombia. METHODS A Markov model simulated the therapeutic management, disease course, and complications in hypothetical cohorts of OAB patients over a 5-year period. The model predicted costs and three outcomes: quality-adjusted life-years (QALYs), micturition state improvement (MSI), and incontinence state improvement (ISI). In each 1-month cycle, patients could transition between different health states reflecting symptom severity. Transition probabilities were estimated from a published mirabegron trial and mixed treatment comparison. Other inputs such as treatment discontinuation based on treatment-specific rates of persistence, resource use and costs, anticholinergic burden, comorbidity treatment, and drug acquisition were obtained from Società Italiana Scienze Mediche, Instituto de Seguros Sociales Tariff Manual, published literature, and expert opinion. Deterministic and probabilistic sensitivity analyses were conducted. Costs are presented in 2017 Colombia Pesos (COP). RESULTS Mirabegron was cost effective for all outcome measures at a willingness-to-pay threshold of 124,919,725 COP, which is three times the per capita gross domestic product (GDP). Using QALYs as the measure of effect, mirabegron had an incremental cost-effectiveness ratio (ICER) of 85,802,036 COP/QALY (26,365 USD/QALY) and 66,360,134 COP/QALY (20,384 USD/QALY) versus oxybutynin and tolterodine, respectively. Probabilistic sensitivity analyses showed that mirabegron was cost effective in 99.5% and 100% of simulations compared with oxybutynin and tolterodine, respectively. Using MSI and ISI as the measure of effects yielded ICERs below one GDP. CONCLUSIONS Mirabegron is a cost effective alternative to oxybutynin and tolterodine from the perspective of a third-party payer in Colombia.
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Affiliation(s)
- Hélène Parise
- Medicus Economics LLC, 2 Stonehill Ln, Milton, MA, 02186, USA
| | - Robert Espinosa
- Medicus Economics LLC, 2 Stonehill Ln, Milton, MA, 02186, USA.
| | - Katherine Dea
- Medicus Economics LLC, 2 Stonehill Ln, Milton, MA, 02186, USA
| | | | | | - Daniel Bin Ng
- Astellas Pharma Global Development, Inc, Northbrook, IL, USA
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Errando-Smet C, Müller-Arteaga C, Hernández M, Roset M. Diagnosis and treatment of male patients with lower urinary tract symptoms in Spain - The MERCURY Study. Do urologists follow the recommendations of the European guidelines? Actas Urol Esp 2018; 42:323-330. [PMID: 29428420 DOI: 10.1016/j.acuro.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore the management of lower urinary tract symptoms (LUTS) in men in Spain and assess the compliance with recommendations established in the European Association of Urology (EAU) guidelines. MATERIAL AND METHODS MERCURY was an epidemiological and cross-sectional study which involved 227 Urology Units across Spain assessing adult male patients with mixed LUTS and persisting storage symptoms. Sociodemographic, clinical and resource use data for the 6 months prior to study inclusion were collected. Additionally, through a theoretical clinical case, clinicians described their attitude toward the diagnostic and therapeutic management of males with mixed LUTS and persisting storage symptoms during the first and second visits. Answer options given to clinicians about LUTS management were aligned with those recommended by EAU guidelines. RESULT 610 patients included in the study were evaluated. 87.7% of them consumed some health resource mainly due to: urologist visits (79.7%), PSA determination (76.6%) and treatment with alpha-blockers (37.5%) and alpha-blockers plus antimuscarinics (37.2%). According to the theoretical clinical case, urologists preference toward diagnostic tools and pharmacological treatment in first visit were mainly PSA determination (97.7%), digital rectal examination (91.4%) and treatment with alphablockers as monotherapy (56.6%), whereas in the second visit uroflowmetry (48.9%), voiding diary (40.3%) and treatment with alpha-blockers plus antimuscarinics (70.6%) were mainly preferred. CONCLUSIONS Urologists attitude toward management of male patients with mixed LUTS and persisting storage symptoms is aligned with that recommended in the EAU guidelines.
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Affiliation(s)
- C Errando-Smet
- Unidad de Urología Funcional y Femenina, Servicio de Urología, Fundació Puigvert, Barcelona, España.
| | - C Müller-Arteaga
- Departamento de Urología, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - M Hernández
- Departamento Médico de Urología, Astellas Pharma S. A., Madrid, España
| | - M Roset
- Health Economics and Outcomes Research, IQVIA, Barcelona, España
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Athavale A, Gooch K, Walker D, Suh M, Scaife J, Haber A, Hadker N, Dmochowski R. A patient-reported, non-interventional, cross-sectional discrete choice experiment to determine treatment attribute preferences in treatment-naïve overactive bladder patients in the US. Patient Prefer Adherence 2018; 12:2139-2152. [PMID: 30349208 PMCID: PMC6190636 DOI: 10.2147/ppa.s178668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Many pharmacotherapeutic treatment options are available for the symptoms of overactive bladder (OAB), each offering varying efficacy, safety, and tolerability profiles that must be carefully considered when selecting treatment. The objective of the present study was to characterize pharmacotherapy treatment preferences of individuals with symptoms of OAB and to examine how preferences differ by both patient characteristics and disease burden metrics. PATIENTS AND METHODS Patient preferences for OAB treatment attributes were examined using a discrete choice experiment (DCE). Attributes were identified through literature review, clinical relevance, and input from patients. Eligible respondents were required to be ≥18 years of age, have a self-reported physician OAB diagnosis or have self-reported symptoms of OAB, and be naïve to pharmacotherapy or invasive OAB treatments. A hierarchical Bayesian random-effects-only model was used to estimate the mean relative preference weights and mean relative importance scores of treatment attributes. Multivariable linear regression models with backward selection were used to analyze the differences in relative importance scores by demographic characteristics and disease burden-related metrics. RESULTS In total, 514 individuals participated in the study. Most respondents were <65 years of age (66.0%), female (68.5%), and reported moderate/severe OAB symptoms (64.2%). Overall, respondents placed the greatest importance on drug delivery method, with a preference for oral and patches over injectables, followed by efficacy defined as reduced daytime micturition and out-of-pocket cost. Multivariable linear regression analyses revealed that females were less likely to select injectables, that symptom control of incontinence was the most important to respondents who reported greater work productivity loss, and that out-of-pocket cost was the most important to respondents with moderate/severe OAB. CONCLUSION OAB treatment preferences vary depending on individual patient characteristics and disease severity. Overall, drug delivery method, reduced daytime micturition, and out-of-pocket costs were the most important treatment attributes among treatment-naïve individuals with symptoms of OAB. Preferences for OAB treatment were also found to vary depending on patient demographics and disease comorbidities, which has previously not been examined.
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Affiliation(s)
| | - Katherine Gooch
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA,
| | - David Walker
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA,
| | | | | | - Ali Haber
- Trinity Partners LLC, Waltham, MA, USA
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Abstract
Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.
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Affiliation(s)
- Yoshitaka Aoki
- Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Heidi W Brown
- Departments of Obstetrics and Gynecology &Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Linda Brubaker
- Department of Reproductive Medicine, University of California San Diego, San Diego, California, USA
| | - Jean Nicolas Cornu
- Department of Urology, Charles Nicolle Hospital, University of Rouen Normandy, Rouen, France
| | - J Oliver Daly
- Department of Obstetrics and Gynaecology, Western Health, Victoria, Australia
| | - Rufus Cartwright
- Department of Urogynaecology, St Mary's Hospital, London, UK
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK
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Validation of overactive bladder questionnaire (1-week recall version) in medically complex elderly patients with overactive bladder. Int Urogynecol J 2017; 28:1857-1863. [DOI: 10.1007/s00192-017-3305-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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Drake MJ, Oelke M, Snijder R, Klaver M, Traudtner K, van Charldorp K, Bongaerts D, Van Kerrebroeck P. Incidence of urinary retention during treatment with single tablet combinations of solifenacin+tamsulosin OCAS™ for up to 1 year in adult men with both storage and voiding LUTS: A subanalysis of the NEPTUNE/NEPTUNE II randomized controlled studies. PLoS One 2017; 12:e0170726. [PMID: 28166296 PMCID: PMC5293258 DOI: 10.1371/journal.pone.0170726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 12/30/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The emergence of urinary retention (UR), specifically acute urinary retention (AUR), has been a concern when treating men with lower urinary tract symptoms (LUTS) with antimuscarinic drugs. MATERIALS AND METHODS In NEPTUNE (12-week, double-blind), men (≥45 years) with LUTS were randomized to receive tamsulosin oral-controlled absorption system (TOCAS) 0.4 mg, fixed-dose combination (FDC) of solifenacin (Soli) 6 mg + TOCAS 0.4 mg, FDC Soli 9 mg + TOCAS 0.4 mg, or placebo. In NEPTUNE II (40-week, open-label extension of NEPTUNE), continuing patients received 4-week FDC Soli 6 mg + TOCAS, then FDC Soli 6 mg or 9 mg + TOCAS for the remainder of the study, switchable every 3 months. RESULTS Across both studies, 1208 men received ≥1 dose of FDC Soli 6 mg or 9 mg + TOCAS for up to 52 weeks; 1199 men completed NEPTUNE and 1066 received ≥1 dose in NEPTUNE II. In total, 13 men (1.1%; 95% CI, 0.6%-1.8%) reported a UR event while receiving FDC, eight of which were AUR (0.7%; 95% CI, 0.3%-1.3%, incidence 7/1000 man-years). Six men reported UR events while taking Soli 6 mg + TOCAS (three AUR), and seven men reported a UR event while taking Soli 9 mg + TOCAS (five AUR). One man developed AUR while taking TOCAS alone and four reported UR (three AUR) during placebo run-in. Most AUR/UR events occurred within 4 months of treatment initiation. CONCLUSIONS FDC Soli and TOCAS was associated with a low rate of UR and AUR in men with LUTS.
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Affiliation(s)
- Marcus J. Drake
- University of Bristol, Bristol, United Kingdom
- Bristol Urological Institute, Bristol, United Kingdom
- * E-mail:
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Kuo HC. OnabotulinumtoxinA Treatment for Overactive Bladder in the Elderly: Practical Points and Future Prospects. Drugs Aging 2015; 33:1-9. [PMID: 26666524 DOI: 10.1007/s40266-015-0335-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Overactive bladder (OAB) increases with age. OAB in the elderly may be associated with increased risks of falls, fractures and mortality. Degeneration of the central nervous system in the elderly is proposed as one of the pathogenic factors for OAB. Recently, onabotulinumtoxinA (BoNT-A) 100 U has been demonstrated to be well tolerated, and it significantly improves all OAB symptoms and health-related quality of life in patients who are inadequately managed with anticholinergics. However, an increased risk of a large post-void residual volume and a lower long-term success rate were noted in frail elderly patients. Careful patient selection for BoNT-A injection treatment is important in elderly OAB patients. Patients who are frail, are elderly, have comorbidity or have a post-void residual volume >100 mL should be monitored carefully after BoNT-A injection treatment to prevent urinary retention and subsequent urinary tract infection. Use of liposomes to carry BoNT-A across the urothelial barrier decreases urgency-frequency episodes without compromising detrusor contractility and might avoid urinary tract infection. This treatment might prevent undesired detrusor underactivity after BoNT-A injection treatment, especially in elderly patients who have low detrusor contractility. For treatment of OAB in the elderly, clinicians should be aware of the balance between therapeutic efficacy and safety.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707, Section 3, Chung Yang Road, Hualien, Taiwan.
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Postmenopausal overactive bladder. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2015; 13:313-29. [PMID: 26327873 PMCID: PMC4352916 DOI: 10.5114/pm.2014.47984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/17/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022]
Abstract
Bladder storage symptoms have a severe impact on many areas as regards the quality of life including health-related, social, psychological and working functions. Pharmacotherapy of lower urinary tract stores (LUTS) has been developed to optimize neural control of the lower urinary tract in pathologic states. The bladder can be overactive or underactive. Overactive bladder (OAB) is highly prevalent and is associated with considerable morbidity, especially in aging population. Therefore, an effective treatment of OAB must result in a meaningful reduction in urinary symptoms. Pharmacotherapy for the OAB must be individualized based on the degree of bother, medication side-effect profile, concomitant comorbidities and current medication regimen. Antimuscarinic agents will continue to represent the current gold standard for the first-line pharmacological management of OAB. Alternatively to antimuscarinic therapy, β3-adrenergic receptor agonists, due to their efficacy and favorable adverse event profile, are a novel and attractive option of pharmacological treatment of overactive bladder symptoms. A combination of selective antimuscarinic and β3-adrenergic receptor agonists, agents with the different mechanism of action, gives a new treatment option for the patient with OAB according to its harms profile. A number of putative novel therapeutic agents is under clinical evaluations that may ultimately provide alternative or combination treatment options for OAB in the nearest future.
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Haab F. Chapter 1: The conditions of neurogenic detrusor overactivity and overactive bladder. Neurourol Urodyn 2015; 33 Suppl 3:S2-5. [PMID: 25042138 DOI: 10.1002/nau.22636] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/18/2014] [Indexed: 01/19/2023]
Abstract
Overactive bladder (OAB) is a symptom syndrome consisting of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence (UUI), in the absence of a causative infection or pathological conditions. The prevalence of OAB is approximately 11-19% in both men and women, and leads to a significant negative effect on a patient's health-related quality of life (HRQOL). OAB is also associated with comorbidities such as urinary tract infection (UTI) and an increased risk of falls. Following behavioral therapy, anticholinergic agents are commonly prescribed, but these often fail because of lack of efficacy and/or poor tolerability. Evaluation of treatment success in OAB should include pre-defined, patient-centered goals. Patients for whom oral therapy has failed to meet such goals may be considered refractory to oral therapy and candidates for minimally invasive therapy. Neurogenic detrusor overactivity (NDO) is a bladder dysfunction frequently observed in patients with conditions such as multiple sclerosis (MS) and spinal cord injury (SCI). Increased storage pressure can put the upper urinary tract at risk of deterioration and reducing this risk is a primary aim of therapy. Urinary incontinence (UI) is reported by approximately 50% of MS patients, and most SCI patients will develop some bladder dysfunction. NDO leads to a negative impact on HRQOL, independent of the impact of the primary condition. NDO patients in whom oral therapy has failed to normalize storage pressure may be considered refractory and are candidates for minimally invasive therapy.
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Dimitropoulos K, Gravas S. Solifenacin/tamsulosin fixed-dose combination therapy to treat lower urinary tract symptoms in patients with benign prostatic hyperplasia. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:1707-16. [PMID: 25834406 PMCID: PMC4372012 DOI: 10.2147/dddt.s53184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Treatment of male lower urinary tract symptoms (LUTS) has traditionally focused on the management of benign prostatic obstruction, but the contribution of bladder dysfunction has been recently recognized. Therefore, it is well understood that LUTS have multifactorial etiology and often occur in clusters and not in isolation. Voiding LUTS are highly prevalent in men, but storage LUTS have been proved to be more bothersome. α1-Blockers are the most widely used pharmacologic agents for the treatment of symptoms relating to benign prostatic enlargement due to benign prostatic hyperplasia (BPH), while antimuscarinics are the drug class of choice for overactive bladder symptoms. A combination of the two drug classes would be a reasonable approach to treat men with both storage and voiding symptoms, and several short-term studies have proved the efficacy and safety of different combinations with an α1-blocker and an antimuscarinic. Following previous studies on the separate administration of solifenacin and tamsulosin, a fixed-dose combination tablet of tamsulosin oral controlled absorption system (OCAS) 0.4 mg and solifenacin succinate 6 mg has been recently introduced, and the current review evaluates the available data on the use of this fixed-dose combination in the treatment of LUTS in men with BPH.
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Affiliation(s)
- Konstantinos Dimitropoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Stavros Gravas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Drake MJ, Chapple C, Sokol R, Oelke M, Traudtner K, Klaver M, Drogendijk T, Van Kerrebroeck P. Long-term safety and efficacy of single-tablet combinations of solifenacin and tamsulosin oral controlled absorption system in men with storage and voiding lower urinary tract symptoms: results from the NEPTUNE Study and NEPTUNE II open-label extension. Eur Urol 2014; 67:262-70. [PMID: 25070148 DOI: 10.1016/j.eururo.2014.07.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/14/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Short-term trials have demonstrated the efficacy and safety of combination therapy using antimuscarinics and α-blockers in men with lower urinary tract symptoms (LUTS). The Study of Solifenacin Succinate and Tamsulosin Hydrochloride OCAS (oral controlled absorption system) in Males with Lower Urinary Tract Symptoms (NEPTUNE) II is the first long-term study using solifenacin (Soli) and the oral controlled absorption system formulation of tamsulosin (TOCAS). OBJECTIVE To evaluate long-term (up to 52 wk) safety and efficacy of flexible dosing of two fixed-dose combinations (FDC) of Soli plus TOCAS in men with moderate to severe storage symptoms and voiding symptoms. DESIGN, SETTING, AND PARTICIPANTS Patients with both storage and voiding LUTS, maximum urinary flow rate of 4.0-12.0 ml/s, prostate size <75 ml, and postvoid residuals ≤ 150 ml, who completed the 12-wk, double-blind NEPTUNE study could continue in the 40-wk, open-label NEPTUNE II study. INTERVENTION FDC of Soli 6 mg plus TOCAS 0.4 mg, or Soli 9 mg plus TOCAS 0.4mg; patients could switch between doses in NEPTUNE II. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Safety and efficacy data from NEPTUNE and NEPTUNE II were combined to cover a 52-wk period. Primary efficacy end points were total International Prostate Symptom Score (IPSS) and total urgency and frequency score (TUFS); secondary end points included IPSS storage and voiding subscores, micturition diary variables, and quality of life parameters. RESULTS In all, 1066 men completed NEPTUNE and received one dose or more of study medication in NEPTUNE II. Treatment-emergent adverse events were reported in 499 (46.8%) patients who participated in NEPTUNE II; most were mild or moderate. Urinary retention occurred in 13 of 1208 (1.1%) patients receiving one or more FDCs in NEPTUNE and/or NEPTUNE II; 8 (0.7%) required catheterisation (acute urinary retention [AUR]). Reductions in total IPSS and TUFS during NEPTUNE were maintained for up to 52 wk of FDC treatment, with mean reductions of 9.0 (standard deviation [SD]: 5.7) and 10.1 (SD: 9.2), respectively, from baseline to end of treatment. Clinically relevant improvements were also observed for secondary efficacy end points. CONCLUSIONS Long-term treatment with FDC Soli plus TOCAS was well tolerated and efficacious in men with storage and voiding LUTS, with a low incidence of AUR. PATIENT SUMMARY Treatment with solifenacin plus tamsulosin in a fixed-dose combination tablet was well tolerated by men with lower urinary tract symptoms. Improvements in symptoms were achieved after 4 wk of treatment, with further improvements at week 16 maintained for up to 52 wk throughout the study.
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Affiliation(s)
- Marcus J Drake
- University of Bristol and Bristol Urological Institute, Bristol, UK.
| | | | - Roman Sokol
- Private Urological Care Centre, Piaristicka, Trencin, Slovakia
| | | | | | - Monique Klaver
- Astellas Pharma Global Development, Leiden, The Netherlands
| | - Ted Drogendijk
- Astellas Pharma Global Development, Leiden, The Netherlands
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Golzarian J, Antunes AA, Bilhim T, Carnevale FC, Konety B, McVary KT, Parsons JK, Pisco JM, Siegel DN, Spies J, Wasserman N, Gowda N, Ahrar K. Prostatic Artery Embolization to Treat Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia and Bleeding in Patients with Prostate Cancer: Proceedings from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2014; 25:665-74. [DOI: 10.1016/j.jvir.2013.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/01/2013] [Accepted: 11/03/2013] [Indexed: 10/25/2022] Open
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Abstract
Prevalence, pathophysiology, diagnostic and therapeutic approaches of urinary incontinence are well studied in women; however, studies on male urinary incontinence focus on incontinence following surgery of the bladder or prostate, predominantly incontinence after radical prostatectomy. Aging men suffer from incontinence, most frequently urge incontinence (overactive bladder, OAB), nearly as often as women do.The domain of conservative therapy of urinary stress incontinence in men is pelvic floor training. It remains unclear whether biofeedback procedures, electrostimulation therapy, or magnetic stimulation therapy can enhance pelvic floor training. There are data suggesting that an off-label therapy with Duloxetin®, a selective serotonin-noradrenaline reuptake inhibitor (SSNRI), improves urinary incontinence following radical prostatectomy. Antimuscarinic agents in combination with bladder training have been proven as safe and effective treatment in men with OAB. Data, however, suggest that men with OAB are far less frequently treated than women.
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Abstract
Overactive bladder (OAB) is a highly prevalent condition, affecting approximately 18% of adult Canadians. The impact of OAB is substantial, negatively affecting quality of life, sexuality and work productivity. Furthermore, patients with OAB are at increased risk of several other important comorbidities, including mood and anxiety disorders. Despite widespread availability of efficacious treatment, research has shown that OAB remains underdiagnosed and undertreated.
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Affiliation(s)
- Sender Herschorn
- Professor, Division of Urology, University of Toronto, and Head of Urodynamics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON
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Efficacy and tolerability of solifenacin in men with overactive bladder: results of an observational study. World J Urol 2013; 32:1041-7. [DOI: 10.1007/s00345-013-1179-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/03/2013] [Indexed: 02/02/2023] Open
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22
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Overactive Bladder in Elderly Men: Epidemiology, Evaluation, Clinical Effects, and Management. Curr Urol Rep 2013; 14:418-25. [DOI: 10.1007/s11934-013-0367-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Cornu JN. Overactive Bladder Medical Management in the Elderly: It Is Time to Go Beyond the Tip of the Iceberg. Eur Urol 2013; 64:82-3. [DOI: 10.1016/j.eururo.2013.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 01/28/2013] [Indexed: 11/30/2022]
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Van Kerrebroeck P, Haab F, Angulo JC, Vik V, Katona F, Garcia-Hernandez A, Klaver M, Traudtner K, Oelke M. Efficacy and safety of solifenacin plus tamsulosin OCAS in men with voiding and storage lower urinary tract symptoms: results from a phase 2, dose-finding study (SATURN). Eur Urol 2013; 64:398-407. [PMID: 23537687 DOI: 10.1016/j.eururo.2013.03.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/08/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Storage symptoms are often undertreated in men with lower urinary tract symptoms (LUTS). OBJECTIVE To evaluate the combination of an antimuscarinic (solifenacin) with an α-blocker (tamsulosin) versus tamsulosin alone in the treatment of men with LUTS. DESIGN, SETTING, AND PARTICIPANTS A double-blind, 12-wk, phase 2 study in 937 men with LUTS (≥ 3 mo, total International Prostate Symptom Score [IPSS] ≥ 13, and maximum urinary flow rate 4.0-15.0 ml/s). INTERVENTION Eight treatment groups: tamsulosin oral controlled absorption system (OCAS) 0.4 mg; solifenacin 3, 6, or 9 mg; solifenacin 3, 6 or 9 mg plus tamsulosin OCAS 0.4 mg; or placebo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary efficacy end point was change from baseline in total IPSS. Secondary end points included micturition diary and quality-of-life (QoL) parameters. Post hoc subgroup analyses were performed by severity of baseline storage symptoms, with statistical comparisons presented only for tamsulosin OCAS alone versus combination therapy, due to the small sample size of the solifenacin monotherapy and placebo subgroups. RESULTS AND LIMITATIONS Combination therapy was associated with significant improvements in micturition frequency and voided volume versus tamsulosin OCAS alone in the total study population; improvements in total IPSS were not significant. Statistically significant improvements in urgency episodes, micturition frequency, total urgency score, voided volume, IPSS storage subscore, IPSS-QoL index, and Patient Perception of Bladder Condition were observed in a subpopulation of men with two or more urgency episodes per 24h (Patient Perception of Intensity of Urgency Scale grade 3 or 4) and eight or more micturitions per 24h at baseline (storage symptoms subgroup) with combination therapy versus tamsulosin OCAS alone (p ≤ 0.05 for the dose-response slope, all variables). Combination therapy was well tolerated, and adverse events were consistent with the safety profiles of both compounds. CONCLUSIONS Solifenacin plus tamsulosin OCAS did not significantly improve IPSS in the total study population but offered significant efficacy and QoL benefits over tamsulosin OCAS monotherapy in men with both voiding and storage symptoms at baseline. Combination therapy was well tolerated. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT00510406.
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Oelke M, Burger M, Castro-Diaz D, Chartier-Kastler E, Cidre MAJ, McNicholas T, Radziszewski P, Kirby M. Diagnosis and medical treatment of lower urinary tract symptoms in adult men: applying specialist guidelines in clinical practice. BJU Int 2011; 110:710-8. [DOI: 10.1111/j.1464-410x.2011.10808.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Nunzio C, Ahyai S, Autorino R, Bachmann A, Bialek W, Briganti A, Reich O, Sosnowski R, Thiruchelvam N, Novara G. Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms: Research Priorities. Eur Urol 2011; 60:1205-6. [DOI: 10.1016/j.eururo.2011.08.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 08/15/2011] [Indexed: 12/23/2022]
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Khullar V. Patient-reported outcomes and different approaches to urinary parameters in overactive bladder: what should we measure? Int Urogynecol J 2011; 23:179-92. [PMID: 22011932 DOI: 10.1007/s00192-011-1526-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 07/21/2011] [Indexed: 11/25/2022]
Abstract
Overactive bladder (OAB) is highly prevalent and associated with considerable impact on patient health-related quality of life (HRQoL). Assessment of HRQoL can reveal the burden of disease and post-intervention improvement. This review aims to highlight the importance of HRQoL assessment and outline the tools available for use in clinical trials and real-world clinical practice. A number of validated measures of HRQoL specific to OAB have been developed, offering greater sensitivity and responsiveness over generic instruments. These condition-specific, multi-dimensional and single-item global questionnaires are particularly useful for the multiple and varied symptoms of OAB, as they reflect the patient's needs, concerns and values. Measurements for lower urinary tract symptoms, e.g. bladder diaries, are being compared with HRQoL instruments to provide greater understanding of the disease and treatment from the patient's perspective. Therapeutic interventions to improve OAB symptoms should also be evaluated for their effect on the patient's HRQoL.
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Affiliation(s)
- Vik Khullar
- Urogynaecology Department, St Mary's Hospital, Imperial College London, London, UK.
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Khullar V, Foote J, Seifu Y, Egermark M. Time-to-effect with darifenacin in overactive bladder: a pooled analysis. Int Urogynecol J 2011; 22:1573-80. [PMID: 22006023 DOI: 10.1007/s00192-011-1522-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 07/21/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was conducted to assess time-to-effect with darifenacin in patients with overactive bladder (OAB). METHODS Efficacy and safety data were pooled from 1,059 patients (19-88 years, 85% women) randomized to darifenacin 7.5 or 15 mg once daily or matched placebo in three double-blind 12-week studies. Patients completed electronic bladder symptom diaries (number of micturitions/day; incontinence episodes/day; urgency episodes/day). A post hoc efficacy analysis was performed on the earliest recorded timepoints. RESULTS The full analysis population comprised 1,053 patients. Statistically significant improvements were observed in all OAB symptoms (except nocturnal awakenings) for both darifenacin doses versus placebo at week 2, with further improvements over 6 and 12 weeks. Both darifenacin doses significantly improved all OAB symptoms from as early as days 6-8 versus placebo. CONCLUSIONS Darifenacin 7.5 and 15 mg significantly reduced OAB symptoms throughout the study. The rapid onset-of-effect is desirable to patients with OAB and useful for their clinical management.
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Affiliation(s)
- Vik Khullar
- Urogynaecology Department, St Mary's Hospital, Imperial College, London, UK.
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Drutz HP. Overactive bladder: the importance of tailoring treatment to the individual patient. J Multidiscip Healthc 2011; 4:233-7. [PMID: 21847345 PMCID: PMC3155853 DOI: 10.2147/jmdh.s21401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Overactive bladder (OAB) is a prevalent and persistent condition that is often under-diagnosed and under-treated, and which frequently requires tailored treatment for successful management. METHODS This consensus opinion-based review summarizes the discussions of a group of experts in the field of OAB that were assembled to evaluate the importance of correct diagnosis and appropriate pharmacotherapy in patients with OAB. RESULTS A thorough diagnostic process is crucial for allowing exclusion of underlying medical issues and differentiation from genitourinary conditions other than OAB. In addition, selecting the most appropriate pharmacotherapy needs to be carefully considered in the context of each patient with OAB. In general, patients with OAB tend to be older with various comorbidities and often receiving multiple concomitant medications. Treatment decisions should take into consideration the differing potential for antimuscarinic medications to alter cognitive and cardiovascular functions, both of which may be compromised in this patient population. CONCLUSION Tailoring treatment to individual patients by comprehensive patient assessment may lead to more effective management of patients with OAB, especially those receiving polypharmacy for comorbidities.
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Affiliation(s)
- Harold P Drutz
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
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Green L, Kerney D. Patient experience with darifenacin - results of a short-term community-based survey in managing overactive bladder. Curr Med Res Opin 2011; 27:431-7. [PMID: 21194391 DOI: 10.1185/03007995.2010.541432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This community-based program evaluated patients' experiences with darifenacin over 3 weeks' treatment in a predominantly primary care clinical practice setting. METHODS Physicians (n = 2117, 50% primary care physicians, 35% urologists, 10% obstetrician/gynecologist, 5% other) were asked to introduce the program to patients with overactive bladder (OAB). Patients received an enrollment kit including a 30-day darifenacin voucher, activated if patients registered for the program via telephone or online. Patients (≥ 18 years of age) completed a brief automated survey to evaluate frequency of urge urinary incontinence episodes (UUIEs), micturitions/24 hours, urge severity/24 hours (10 point scale: 0 = not at all severe; 10 = very severe), and treatment tolerability (10 point scale: 0 = very poorly tolerated; 10 = very well tolerated). Patients also completed a second survey 3 weeks after starting darifenacin. Statistical analyses were not prospectively planned or performed. RESULTS A total of 2165 patients completed both surveys. At baseline, mean age of completers was 66 years, 76% were female, and 47% reported prior use of OAB medications. After 3 weeks' treatment, patients experienced reductions in UUIEs and micturitions. Urge severity was reduced by >30% after 3 weeks (mean scores: 6.7 at baseline vs. 4.6 after 3 weeks' treatment) and treatment was well tolerated (mean score: 7.7). Overall, 85% of patients who participated in the program did so due to physician influences. CONCLUSIONS The results of this 3-week, self-reported community-based survey indicate that patients were generally satisfied with darifenacin treatment and experienced a reduction in OAB symptoms. Darifenacin was generally well tolerated.
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Affiliation(s)
- Lonny Green
- Virginia Women's Center, Richmond, VA 23233, USA.
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Current world literature. Curr Opin Urol 2010; 21:84-91. [PMID: 21127406 DOI: 10.1097/mou.0b013e328341a1a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reply from Authors re: Roger Dmochowski. On Data Sets, Extrapolations, and Urologic Issues. Eur Urol 2010;57:592–3. Eur Urol 2010. [DOI: 10.1016/j.eururo.2010.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dmochowski R. On Data Sets, Extrapolations, and Urologic Issues. Eur Urol 2010; 57:592-3; discussion 594. [DOI: 10.1016/j.eururo.2010.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 01/04/2010] [Indexed: 11/25/2022]
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