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Hajebrahimi S, Pourmohammad A, Konstantinidis C, Samarinas M, Morsali S, Mostafaei H, Farhoudi M, Rahnama'i MS, Beheshti R, Salehi-Pourmehr H. Safety and Efficacy of Trospium Chloride and Solifenacin in Stroke-Induced Neurogenic Lower Urinary Tract Dysfunction: A Randomized Controlled Trial. Neurourol Urodyn 2025; 44:85-95. [PMID: 39469916 DOI: 10.1002/nau.25614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 09/24/2024] [Accepted: 10/14/2024] [Indexed: 10/30/2024]
Abstract
BACKGROUND Neurogenic dysfunction of the lower urinary tract is one of the challenging diseases with high burdens in urology. Our study aims to evaluate the efficacy of a 4-week treatment with Solifenacin and Trospium chloride and assess their safety and impact on quality of life. METHODS Following the selection of 206 stroke patients from two centers who met specific eligibility criteria, including a clinical diagnosis of stroke, normal cognitive function, and the presence of lower urinary tract symptoms (LUTS), participants were randomly assigned to receive oral Solifenacin, Trospium chloride, or a placebo. Under the supervision of the Ethics Committee, the baseline characteristics, compliance with medication, and outcomes were monitored, gathered, and analyzed. RESULTS The majority of participants were male, with a mean age of 67.3, and most had ischemic stroke. The groups had no significant difference in urinary symptoms after stroke. All of the symptoms in the study groups, according to the NBSS questionnaire, were decreased following treatment compared to the baseline (p < 0.05). After treatment, ICIQ-OAB, and ICIQ-LUTS-QOL total scores and bothersome scores decreased significantly compared to baseline (p < 0.001). When compared to the placebo, both Trospium chloride and Solifenacin alleviated symptoms according to the NBSS questionnaire and ICIQ-LUTS-QOL, total ICIQ-OAB, and the total score of ICIQ-OAB-Bothersome. However, the total LUTS-QOL-Bothersome score did not change in the active treatment groups compared to the placebo. While comparing the two drugs, these values were similar except for the total score of LUTS-QOL-Bothersome, ICIQ-OAB, and ICIQ-OAB-Bothersome in favor of the Solifenacin group. Moreover, Solifenacin had fewer side effects compared to Trospium chloride or placebo. CONCLUSION The study analyzed 206 stroke patients in two international centers and found both drug arms effective in treating overactive bladder. However, inconsistencies were found in efficacy and safety, necessitating further studies with larger populations. TRIAL REGISTRATION This triple-blind, multicenter, randomized controlled trial was done on 206 stroke patients after getting Ethical Committee approval and registering the project on IRCT (IRCT20160606028304N2).
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Affiliation(s)
- Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Urology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Pourmohammad
- Urology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Soroush Morsali
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rasa Beheshti
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Moss DE. Is Combining an Anticholinergic with a Cholinesterase Inhibitor a Good Strategy for High-Level CNS Cholinesterase Inhibition? J Alzheimers Dis 2020; 71:1099-1103. [PMID: 31476160 DOI: 10.3233/jad-190626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The currently approved cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) produce gastrointestinal toxicity which limits dosing to that which produces only about 25% to 35% CNS cholinesterase inhibition in Alzheimer's disease patients undergoing treatment, below the minimum therapeutic target of about 40% to 50% CNS inhibition considered necessary to treat cognitive impairment. A recent strategy for producing high-level CNS acetylcholinesterase (AChE) inhibition (50% or higher) is to co-administer a muscarinic anticholinergic with the AChE inhibitor to block the dose-limiting cholinergic overstimulation of the gastrointestinal system, allow more robust AChE inhibition in the CNS, and improve efficacy in the treatment of Alzheimer's disease. Unfortunately, most common muscarinic anticholinergics, including solifenacin, readily penetrate the CNS and are directly associated with long-term exacerbation of the underlying neuropathology of Alzheimer's disease and increased brain atrophy. The co-administration of an anticholinergic with an AChE inhibitor is a rational strategy for improving efficacy in the symptomatic treatment of dementia, but there are significant long-term risks that have not yet been considered. For long-term safety against accelerating the underlying disease processes in Alzheimer's disease, anticholinergics used to increase the tolerability of AChE inhibitors should not penetrate, or have very limited penetration, of the blood-brain barrier. Neurotrophic-mediated mechanisms by which cholinergic drugs may affect neurodegeneration in Alzheimer's disease are explored and improved treatment options are suggested.
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Affiliation(s)
- Donald E Moss
- Department of Psychology, University of Texas at El Paso, El Paso, TX, USA
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Mostafaei H, Shariat SF, Salehi-Pourmehr H, Janisch F, Mori K, Quhal F, Hajebrahimi S. The clinical pharmacology of the medical treatment for overactive bladder in adults. Expert Rev Clin Pharmacol 2020; 13:707-720. [PMID: 32500759 DOI: 10.1080/17512433.2020.1779056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Overactive bladder is a prevalent symptom complex that affects the patient's quality of life. Any disruption between the neuronal micturition pathway can lead to bladder overactivity. Neurogenic causes, myogenic causes, aging, bladder outlet obstruction, sex, and psychological factors are some of the factors contributing to bladder overactivity. The complaint of any symptoms of OAB, which is highly prevalent and affects overall QOL, often needs therapeutic interventions. When conservative therapy methods fail, the addition of medications is recommended. The most commonly used agents for the treatment of OAB are antimuscarinic drugs. New classes of drugs, such as beta-3 agonists, have enriched our pharmacologic armamentarium. AREAS COVERED In this review, with a special focus on oral pharmacological treatments, we discussed the definition, etiology, symptoms, diagnosis, and management of OAB. EXPERT OPINION OAB is a multifactorial condition with every patient presenting with a different collection of symptoms and signs. Medical therapies should be given in conjunction with behavioral therapies. Using high or low doses, flexible doses, and stopping or changing the medications are interchangeable strategies based on the level of treatment efficacy and patient satisfaction.
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Affiliation(s)
- Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University , Moscow, Russia.,Department of Urology, University of Texas Southwestern Medical Center , Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University , Prague, Czech Republic.,Department of Urology, Weill Cornell Medical College , New York, NY, USA.,Karl Landsteiner Institute of Urology and Andrology , Vienna, Austria.,Department of Urology, University of Jordan , Amman, Jordan
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Florian Janisch
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Department of Urology, Medical University of Hamburg , Hamburg, Germany
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Department of Urology, The Jikei University School of Medicine , Tokyo, Japan
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,King Fahad Specialist Hospital-Dammam , Saudi Arabia
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
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Deutsch B, Neumeister C, Schwantes U, Fromm MF, König J. Interplay of the Organic Cation Transporters OCT1 and OCT2 with the Apically Localized Export Protein MATE1 for the Polarized Transport of Trospium. Mol Pharm 2019; 16:510-517. [PMID: 30656943 DOI: 10.1021/acs.molpharmaceut.8b00779] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The anticholinergic drug trospium is secreted into urine and, to a smaller extent, into bile. Chemically, it is an organic cation, and it is a substrate of the uptake transporters OCT1 and OCT2 as well as for the export proteins MATE1 and MATE2-K as determined in uptake studies using HEK293 cells. So far, neither MATE-mediated export nor the interplay of OCT-mediated uptake and MATE-mediated export have been investigated. Therefore, we used polarized monolayers of single- and double-transfected MDCKII cells (MDCK-OCT1, MDCK-OCT2, MDCK-MATE1, MDCK-OCT1-MATE1, and MDCK-OCT2-MATE1) and the respective control cells (MDCK-Co) for transcellular transport assays. We demonstrate that the transcellular, basal-to-apical transport of trospium is significantly higher in all cell lines compared to control cells over nearly the complete concentration range tested. The transcellular transport mediated by double-transfected MDCK-OCT1-MATE1 and MDCK-OCT2-MATE1 exceeded that in the single-transfected cells (MDCK-OCT1-MATE1 vs MDCK-OCT1: 2.2-fold; MDCK-OCT1-MATE1 vs MDCK-MATE1: 1.7-fold; MDCK-OCT2-MATE1 vs MDCK-OCT2: 6.1-fold; MDCK-OCT2-MATE1 vs MDCK-MATE1: 1.8-fold at a trospium concentration of 1.0 μM; p < 0.001 each). Thus, we show that MATE1 does not only mediate the uptake of trospium into HEK293 cells but also the efflux of trospium out of polarized MDCKII-cells. Furthermore, our results indicate that OCT1 or OCT2 as uptake transporters and MATE1 as an export protein contribute to the transcellular transport of trospium at concentrations normally reached during trospium therapy. These data suggest that both, OCT-mediated uptake as well as MATE1-mediated efflux may contribute to trospium renal and biliary elimination.
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Affiliation(s)
- Birgit Deutsch
- Institute of Experimental and Clinical Pharmacology and Toxicology , Friedrich-Alexander-Universität Erlangen-Nürnberg , 91054 Erlangen , Germany
| | | | | | - Martin F Fromm
- Institute of Experimental and Clinical Pharmacology and Toxicology , Friedrich-Alexander-Universität Erlangen-Nürnberg , 91054 Erlangen , Germany
| | - Jörg König
- Institute of Experimental and Clinical Pharmacology and Toxicology , Friedrich-Alexander-Universität Erlangen-Nürnberg , 91054 Erlangen , Germany
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Panda SS, Ravi Kumar BVV, Mohanta G, Dash R, Patel PK. New Stability-Indicating RP-UFLC Method for Determination of Trospium Chloride in Tablet Dosage Form. Sci Pharm 2012; 80:955-64. [PMID: 23264942 PMCID: PMC3528044 DOI: 10.3797/scipharm.1207-07] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 08/31/2012] [Indexed: 11/22/2022] Open
Abstract
A simple, precise, and accurate isocratic RP-UFLC stability-indicating assay method has been developed to determine trospium chloride in tablet dosage form. Isocratic separation was achieved on an Enable-C18G (250 mm × 4.6 mm i.d., particle size 5 μm) column at room temperature, the mobile phase consisted of acetonitrile:0.01M TBAHS (50:50, v/v) at a flow rate of 1.0 ml/min, the injection volume was 20 μl, and PDA detection was carried out at 215 nm. The drug was subjected to acid and alkali hydrolysis, oxidation, photolysis, and heat as stress conditions. The method was validated for specificity, linearity, precision, accuracy, robustness, and system suitability. The method was linear in the drug concentration range of 10-300 μg/ml with the correlation coefficient being 0.999. The RSD for repeatability and intermediate precision was well below 2%. The mean recoveries were between 100.52-101.68% for trospium chloride.
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Affiliation(s)
- Sagar Suman Panda
- Department of Pharmaceutical Analysis and Quality Assurance, Roland Institute of Pharmaceutical Sciences, Khodasingi, 760010, Berhampur (Odisha), India
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Staskin DR, Chawla RK, Oefelein MG. Pharmacodynamics of Overactive Bladder Drugs: Shifting the Curve. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-010-0080-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bürst M, Wolf A. Efficacy and Safety of Trospium Chloride Use in Children With Idiopathic and Neurogenic Detrusor Overactivity: An Overview of Available Data. ACTA ACUST UNITED AC 2011. [DOI: 10.3834/uij.1944-5784.2011.02.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
UNLABELLED AIMS We examined the relative efficacy and safety of trospium 20 mg bid and 60 mg extended release formulations and position this drug against other antimuscarinic agents. METHODS Data were identified on the pharmacology and pharmacokinetics of trospium chloride. Key publications on trospium 20-mg and 60-mg clinical studies in patients with overactive bladder (OAB) were identified and efficacy and safety compared between these formulations as well as other antimuscarinic agents. RESULTS Trospium offers the principal advantage over other antimuscarinic agents that, as it is a quaternary amine, it does not cross the blood-brain barrier and is therefore less likely to cause central nervous system effects observed with several other agents. Moreover, with its minimal liver metabolisation, independent of the main cytochrome pathways, trospium has a low risk of drug-drug interaction in patients taking multiple pharmacological agents. Trospium 60 mg ER is as effective as trospium 20 mg bid in improving the key outcome parameters associated with OAB, but with a lower rate of dry mouth, the most common side effect of these agents. Trospium has comparable efficacy and safety to the other antimuscarinic agents currently marketed. DISCUSSION Good patient persistence with treatment has been reported with trospium. There are currently a large number of antimuscarinic drugs on the market without clear evidence to distinguish one agent from another in terms of efficacy, provided that an adequate dose is used in the clinical setting. CONCLUSION The new formulation of trospium is certainly worth considering as a pharmacological treatment of patients with OAB, particularly in the elderly, in whom one wants to avoid the potential for cognitive dysfunction.
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Affiliation(s)
- C Chapple
- Royal Hallamshire Hospital, Sheffield, UK
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Pharmacologic management of urinary incontinence, voiding dysfunction, and overactive bladder. Obstet Gynecol Clin North Am 2010; 36:493-507. [PMID: 19932412 DOI: 10.1016/j.ogc.2009.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Most drugs used in the treatment of urinary incontinence and voiding dysfunction in women modulate neuromuscular transmission in the urethra and bladder. Pharmacotherapy is the mainstay of treatment for overactive bladder. Although several different antimuscarinic medications are available for the treatment of overactive bladder, most have similar efficacy and tolerability. Pharmacotherapy has a limited role in the management of stress incontinence and voiding dysfunction in women. Newer drugs that target different mechanisms of action are being developed for the treatment of urinary incontinence and voiding dysfunction in women.
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Ozdedeli S, Karapolat H, Akkoc Y. Comparison of intravaginal electrical stimulation and trospium hydrochloride in women with overactive bladder syndrome: a randomized controlled study. Clin Rehabil 2010; 24:342-51. [DOI: 10.1177/0269215509346092] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the effects of trospium hydrochloride and electrical stimulation on urodynamic parameters, bladder diary, quality of life and psychological symptoms in female patients with overactive bladder syndrome. Design: Prospective, randomized controlled trial. Setting: Department of Physical Medicine and Rehabilitation, University Hospital. Subjects: Thirty-five patients were divided into either trospium chloride (Group 1) or intravaginal electrical stimulation therapy (Group 2). Main outcome measures: All patients were assessed at the beginning of the treatment, at weeks 6 (end of treatment), 10 and 18 according to urodynamic parameters, voiding diary parameters, severity of urgency (visual analogue scale, VAS), the Incontinence Impact Questionnaire Short Form (IIQ-7), and the Beck Depression Inventory. Results: Statistically significant improvements were observed in both groups according to some urodynamic parameters, voiding diary parameters, VAS urgency severity, Incontinence Impact Questionnaire Short Form and Beck Depression Inventory scores at the end of the treatment (P<0.05). During the 18-week follow-up period, deteriorations were observed in many parameters in both groups although improvements in the frequency of urgency, the frequency of incontinence episodes, VAS urgency severity, and Beck Depression Inventory score in Group 2 persisted (P<0.05). Significant differences were not detected between groups at the end of the treatment or during the posttreatment follow-up controls (P>0.05). Conclusion: No difference was detected between trospium hydrochloride and intravaginal electrical stimulation in the treatment of female overactive bladder syndrome. Discontinuation of both treatments caused deterioration in most of the objective and subjective symptoms of overactive bladder syndrome.
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Affiliation(s)
- Selcen Ozdedeli
- Ege University Medical Faculty Physical Medicine and Rehabilitation Department, Bornova, Turkey
| | - Hale Karapolat
- Ege University Medical Faculty Physical Medicine and Rehabilitation Department, Bornova, Turkey,
| | - Yesim Akkoc
- Ege University Medical Faculty Physical Medicine and Rehabilitation Department, Bornova, Turkey
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Dmochowski RR, Rosenberg MT, Zinner NR, Staskin DR, Sand PK. Extended-release trospium chloride improves quality of life in overactive bladder. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:251-257. [PMID: 19818062 DOI: 10.1111/j.1524-4733.2009.00652.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Overactive bladder syndrome (OAB) is a urinary condition that often exerts detrimental effects on an individual's quality of life (QoL). A once-daily, extended-release (ER) formulation of the quaternary amine trospium chloride has recently been developed for the treatment of OAB. The pooled health-related QoL (HRQoL) data from two multicenter, parallel-group, double-blind Phase III studies with trospium chloride ER 60 mg were analyzed. METHODS Subjects aged>or=18 years with urinary urgency, frequency, and an average of >or=1 urge urinary incontinence episode per day on a 3-day bladder diary were randomized (1:1) to receive once-daily trospium 60 mg ER or placebo for 12 weeks. HRQoL was assessed at baseline and at Week 12 using the King's Health Questionnaire (KHQ) and the OAB questionnaire (OAB-q). RESULTS Overall, 1165 subjects were randomized (trospium ER, n=578; placebo, n=587). Trospium ER produced significantly greater improvements from baseline than placebo in seven of the nine KHQ domains. At Week 12, the improvement in mean OAB-q HRQoL total score (from approximately 52 at baseline) was significantly greater with trospium ER than with placebo (+25.8 vs. +20.7; P=0.0003). Improvements from baseline were seen with trospium ER on all eight of the OAB-q symptom bother scales. CONCLUSIONS Once-daily trospium 60 mg ER improved the QoL of subjects with OAB, as assessed using the KHQ and the OAB-q, in two large Phase III clinical trials.
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Affiliation(s)
- Roger R Dmochowski
- Department of Urology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Ashok K, Wang A. Detrusor overactivity: an overview. Arch Gynecol Obstet 2010; 282:33-41. [PMID: 20191279 DOI: 10.1007/s00404-010-1407-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 02/09/2010] [Indexed: 11/27/2022]
Abstract
Detrusor overactivity (DO) is a common clinical problem having profound effects on the quality of life (QOL) of women. With the use of meshes in the antiincontinence surgery, a new onset of DO, de novo DO has become an important issue in postoperative QOL of women. A systematic review of English language literature was conducted from Pubmed and publications of the last 7 years were analyzed and presented in this review. Multiple pathological events in the urothelium, sub-urothelium and possibly in the detrusor muscle seem to underlie the pathophysiology of DO. A variety of approaches, from life style modification to minimal-invasive surgery are available to treat DO and it is the responsibility of the physician to properly select and apply these modalities with the ultimate aim in improving the QOL of the patients. It is imperative to know the various pathophysiological processes that underlie the causation of DO to select proper management approach.
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Affiliation(s)
- Kiran Ashok
- Department of Urogynecology, Chang-Gung Memorial Hospital, Linkou, Taiwan.
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Staskin DR, Rosenberg MT, Sand PK, Zinner NR, Dmochowski RR. Trospium chloride once-daily extended release is effective and well tolerated for the treatment of overactive bladder syndrome: an integrated analysis of two randomised, phase III trials. Int J Clin Pract 2009; 63:1715-23. [PMID: 19930332 DOI: 10.1111/j.1742-1241.2009.02189.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Trospium chloride is an antimuscarinic agent with a hydrophilic polar quaternary amine structure that is minimally metabolised by hepatic cytochrome P450 and is actively excreted in the urine, each of which confers a potential benefit with regard to efficacy and tolerability. PURPOSE We analysed pooled data from two identically designed phase III trials of a once-daily, extended-release (XR) formulation of trospium chloride (trospium XR 60-mg capsules) in subjects with overactive bladder syndrome (OAB). METHODS Adults with OAB of > or = 6 months' duration with urinary urgency, frequency and > or = 1 urge urinary incontinence (UUI) episode/day were enrolled in these multicentre, parallel-group, double-blind trials. Participants were randomised (1 : 1) to receive trospium XR 60 mg or placebo for 12 weeks. Primary efficacy variables were changes in urinary frequency and the number of UUI episodes/day. Adverse events (AEs) were recorded throughout. RESULTS In total, 1165 subjects were randomised (trospium XR, 578; placebo, 587). At baseline, subjects averaged 12.8 toilet voids/day and 4.1 UUI episodes/day. Compared with placebo, subjects treated with trospium XR had significantly greater reductions from baseline in the mean number of toilet voids/day (-1.9 vs. -2.7; p < 0.001) and UUI episodes/day (-1.8 vs. -2.4; p < 0.001) at week 12. The most frequent AEs considered possibly related to study treatment were dry mouth (trospium XR, 10.7%; placebo, 3.7%) and constipation (trospium XR, 8.5%; placebo, 1.5%). Notably, rates of central nervous system (CNS) AEs were lower with trospium XR vs. placebo (dizziness: 0.2% vs. 1.0%; headache: 1.4% vs. 2.4%). CONCLUSIONS Treatment with trospium XR resulted in statistically significant improvements in both of the dual primary and all of the secondary outcome variables. Trospium XR demonstrated favourable rates of AEs, particularly CNS AEs (numerically lower than with placebo) and dry mouth (lower than previously reported with trospium immediate-release, although not compared in a head-to-head study).
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Affiliation(s)
- D R Staskin
- Division of Urology, Caritas-St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
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Staskin DR, Traub S. Pharmacokinetics of overactive bladder drugs: Getting ahead of the curve. CURRENT BLADDER DYSFUNCTION REPORTS 2009. [DOI: 10.1007/s11884-009-0006-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Biastre K, Burnakis T. Trospium chloride treatment of overactive bladder. Ann Pharmacother 2009; 43:283-95. [PMID: 19193592 DOI: 10.1345/aph.1l160] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the pharmacology, pharmacokinetics, safety, and clinical application of trospium chloride for the management of overactive bladder (OAB). DATA SOURCES Clinical literature including both primary sources and review articles was accessed through MEDLINE, International Pharmaceutical Abstracts, and Cochrane databases from 1980 through January 8, 2009. Search terms included overactive bladder, urge urinary incontinence, muscarinic receptor antagonists, and urinary frequency. Further data sources were identified from bibliographies of selected articles. STUDY SELECTION AND DATA EXTRACTION Basic pharmacology data were extracted from animal studies and pharmacokinetic data were gathered from human studies. Multicenter, parallel, randomized, double-blind, placebo-controlled studies were included to describe the efficacy and adverse effects of trospium. DATA SYNTHESIS Trospium chloride is an antimuscarinic agent indicated for the treatment of OAB with symptoms of urge urinary incontinence, urgency, and urinary frequency. Trospium has 3 chemical and pharmacokinetic properties unique among antimuscarinic agents: it is a positively charged quaternary ammonium compound with minimal central nervous system penetration; it is not metabolized by the cytochrome P450 system, resulting in a lower tendency for drug interactions; and it is excreted mainly unchanged in the urine as the active parent compound, providing local activity to achieve early onset of clinical effect and prolonged efficacy. In two 12-week, randomized, placebo-controlled clinical studies in adults with OAB, trospium 20 mg twice daily was more effective than placebo in reducing the number of micturitions per 24 hours, reducing the number of urge incontinence episodes per week, and increasing the volume of urine voided per micturition. Placebo-controlled trials report efficacy with trospium in treatment of OAB; comparative trials with other anticholinergic agents are limited. Current therapy of OAB consists primarily of anticholinergic drugs such as oxybutynin, which are associated with therapy-limiting adverse effects. Because the prevalence of OAB is greatest among the elderly, safety considerations regarding renal function must be noted, with dosage adjustment required in patients with severe renal impairment. CONCLUSIONS Whether the pharmacodynamic properties of trospium make it superior to other therapies will require considerable additional experience with the drug. For now, it appears to be a feasible alternative for patients who cannot tolerate oxybutynin.
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Affiliation(s)
- Kelly Biastre
- Baptist Medical Center, Jacksonville, FL 32207, USA.
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Bittner N, Merrick GS, Brammer S, Niehaus A, Wallner KE, Butler WM, Allen ZA, Galbreath RW. Role of Trospium Chloride in Brachytherapy-Related Detrusor Overactivity. Urology 2008; 71:460-4. [DOI: 10.1016/j.urology.2007.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 09/11/2007] [Accepted: 10/19/2007] [Indexed: 11/16/2022]
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Wein AJ. Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology. J Urol 2007. [DOI: 10.1016/j.juro.2007.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bibliography. Current world literature. Female urology. Curr Opin Urol 2007; 17:287-90. [PMID: 17558274 DOI: 10.1097/mou.0b013e3281fbd54d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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