Dealing with complex overactive bladder syndrome patient profiles with focus on fesoterodine: in or out of the EAU guidelines?

Abstract

Overactive bladder (OAB) syndrome is a common, complex, and challenging condition. To assist the management of these patients, the European Association of Urology (EAU) updates its guidelines annually. This review reports the presentations from the symposium titled “Dealing with complex OAB patient profiles: in or out of the EAU guidelines?” held at the 32nd EAU Annual Congress in March 2017 in London. The symposium focused on three groups of OAB patients: women who may also suffer pelvic organ prolapse, stress urinary incontinence, the genitourinary syndrome of menopause (GSM); patients at risk of cognitive impairment; and elderly patients. The aim of the symposium was to determine how the 2017 EAU guidelines can best assist physicians, as well as to assess the benefits of fesoterodine in these patients. The EAU guidelines recommend antimuscarinic agents (grade A) for the medical treatment of OAB. In women, OAB is correlated with GSM, both of which are underdiagnosed and undertreated. Fesoterodine decreases OAB symptoms and the associated limitation of physical activity. A combination of fesoterodine and vaginal estrogens is appropriate for OAB associated with GSM. In patients at risk of cognitive impairment, prescribers should pay particular attention to the choice of medication. Fesoterodine is a Pgp substrate with limited ability to cross the blood–brain barrier, which may explain the lack of negative effects on the central nervous system observed in clinical trials of this agent. OAB should not be regarded as a normal consequence of aging. Fesoterodine has been extensively investigated in the elderly, and is the only anticholinergic drug licensed for OAB in this population, rated B (beneficial) according to the Fit for the Aged classification for lower-urinary-tract symptoms. The EAU guidelines are a valuable resource for physicians managing patients with OAB, and the pharmacological properties of fesoterodine offer credible clinical advantages in these three patient groups.

Safety and Tolerability of Fesoterodine in Older Adult Patients with Overactive Bladder

“…(8) The belief that incontinence is normal for getting older, and a lack of awareness that incontinence is a treatable condition, may prevent access to diagnosis and treatment. (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) The economic impact of OAB is growing with the increasing older population. Excess annual direct costs associated with the diagnosis, treatment, medical consultations, and treatment of depression associated with OAB have been estimated at between 255€ to 584€ per patient, depending on the European country included in the EPIC study.…”

“…This simple metabolism may explain the consistency of response to fesoterodine across patients. (11,29) The active metabolite of fesoterodine does not inhibit or induce cytochrome P450 enzymes. Patients with hepatic dysfunction have altered cytochrome P450 metabolism and, as this enzyme is needed for clearance of oxybutynin, tolterodine, darifenacin, and solifenacin, (30) fesoterodine is more suitable in these patients.…”

Fesoterodine for the treatment of overactive bladder: pharmacological bases and clinical results

“…J. Heesakkers et al [51] указывают на целесообразность назначения фезотеродина больным из так называемых особых групп. Во-первых, женщинам с генитоуринарным синдромом, которым фезотеродин рекомендуется назначать в комбинации с местной (вагинальной) эстрогензаместительной терапией.…”

“…Во-вторых, пациентам с риском когнитивных нарушений, поскольку фезотеродин обладает ограниченной способностью проникать через гематоэнцефалический барьер и оказывать негативное действие на центральную нервную систему (ЦНС). В-третьих, больным пожилого возраста из-за высокого профиля безопасности препарата [51]. На сегодняшний день фезотеродин является единственным антихолинергическим препаратом, рекомендованным для лечения ГМП у пожилых пациентов.…”

<p>Urinary Urgency: A Symptom In Need Of A Cure</p>

“…Fesoterodine is immediately and completely metabolized into its active form, 5-hydroxymethyl tolterodine (5-HMT), by ubiquitous plasma esterases and is therefore not affected by the genetic variability in hepatic enzymes, and thus shows low inter-individual clinical variability 15. Fesoterodine also has a well-balanced affinity ratio for the detrusor M2 and M3 receptors, reducing parasympathetic activity during the storage phase, which results in an increase in functional bladder capacity 16,17. As a result of its prolonged release formulation and its 7–9-hr half-life, fesoterodine can be taken daily as a single dose without the risk of accumulation of the active ingredient 18.…”