Tolterodine once-daily: superior efficacy and tolerability in the treatment of the overactive bladder

Kerrebroeck, Philip Van; Kreder, Karl J.; Jonas, Udo; Zinner, N.; Wein, Alan J.

doi:10.1016/s0090-4295(00)01113-4

Cited by 432 publications

(257 citation statements)

References 18 publications

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“…13 They are associated with significant side effects because of their action on nonspecific muscarinic receptors: 14,15 symptoms such as dry mouth, constipation and blurred vision are common and not well tolerated and may explain why this treatment is often discontinued. 9,13,16,17 This is an additional bias to evaluate their real effectiveness. At the time of the study, oxybutynin and trospium were the only anticholinergic drugs fully licensed and refunded in France, tolterodine being licensed but not refunded.…”

Section: Discussionmentioning

confidence: 99%

Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients?

Hadiji¹,

Prévinaire

Benbouzid³

et al. 2014

Spinal Cord

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Objectives: To evaluate the efficacy of anticholinergic agents in the treatment of neurogenic overactive bladder (NOAB) and neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients on clean intermittent catheterisation (CIC). Methods: Chronic suprasacral SCI patients on CIC presenting with at least one urinary leakage a day were included. Urodynamics and voiding diaries were performed at baseline and 1 month follow-up. In case of NDO at baseline, an anticholinergic drug was prescribed. Results: The 231 SCI patients presented with one to five urinary leakages per day (mean 2.1). Urodynamics showed NDO in all patients. A new anticholinergic treatment was started in all, either in monotherapy (134 patients) or in association with the existing anticholinergic drug (oxybutynin þ trospium bitherapy, 97 patients). The mean maximum bladder capacity significantly increased from 225 to 441 ml, and the mean involuntary detrusor contractions (IDC) significantly decreased from 67 to 41 cm H 2 O. Only 75 SCI patients (32%) were fully continent. However, 25 out of these 75 patients showed persistent NDO, with amplitudes of IDC above 40 cm H 2 O in 12 patients. Incontinence was still found in 156 SCI patients (67%), with an average of 1,2 leakages a day. In 100 patients, amplitudes of IDC remained above 40 cm H 2 O. There was no statistical difference between patients on anticholinergic monotherapy or bitherapy at follow-up. Conclusion: Anticholinergic treatment is not always satisfactory in terms of control of NDO and rarely allows full continence. INTRODUCTIONThe quality of life of patients presenting with spinal cord injury (SCI) is frequently impaired by lower urinary tract dysfunction. In supra-sacral SCI lesions, neurogenic overactive bladder (NOAB) is common, with symptoms including urgency, with or without urge incontinence, frequency and nocturia. 1 Patients with NOAB are often found to have neurogenic detrusor overactivity (NDO), an urodynamic observation characterised by involuntary detrusor contractions (IDCs) during the filling phase that is either spontaneous or provoked. 2 Amplitudes of IDC greater than 40 cm H 2 O pose a threat to the upper urinary tract. 3 Oral antimuscarinic agents have been widely used as first-line treatment for patients with NDO. However, they are ineffective in some patients and are often associated with bothering side effects such as dry mouth, constipation and blurred vision. 2,4 The clinical and urodynamic efficacy of anticholinergic agents in SCI patients has been evaluated in a limited number of studies. [5][6][7][8][9] They all showed a significant decrease in the number of leakages per day with improved quality of life. Urodynamic testing showed significant improvement in maximum bladder capacity (BCmax) and significant reduction in amplitudes of IDC. However, these were mainly short-term studies, using different evaluation criteria, with different drugs at flexible doses. Surprisingly, patients presenting with daily leakages and persistence of IDC (as high as 35...

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Section: Discussionmentioning

confidence: 99%

Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients?

Hadiji¹,

Prévinaire

Benbouzid³

et al. 2014

Spinal Cord

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“…1 In most cases, antimuscarinics are used as monotherapy and are reported to have higher efficacy with increased dosage. [2][3][4] However, for some patients, antimuscarinic medication has a limited effect or falls short due to its associated adverse events. 5 For refractory OAB symptoms, recent studies have investigated a therapeutic strategy with a combination of two antimuscarinics.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and tolerability of combined medication of two different antimuscarinics for treatment of adults with idiopathic overactive bladder in whom a single agent antimuscarinic therapy failed

Jeong

Chung

et al. 2013

CUAJ

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Objective: Recent studies have investigated a combination of two antimuscarinics for adult neurogenic bladder managed with clean intermittent catheterization or pediatric refractory overactive bladder (OAB). We assessed the efficacy and tolerability of this strategy in adults with idiopathic OAB. Methods: We reviewed 49 patients with idiopathic OAB who received combined antimuscarinic medication. Patients had serially received different kinds of antimuscarinics as monotherapy, but wished to take combined medication due to a lack of sufficient subjective improvement in urgency, even with dosage escalation. Efficacy was measured by changes of episodes of urgency, daytime voiding, nocturia and mean voided volume before and after the addition of the second antimuscarinic. Results: The mean duration of combined medication was 9.3 months. After adding the second antimuscarinic, urgency per day decreased from 3.8 to 1.9 (p < 0.001) and daytime voiding decreased from 10.4 to 7.4 (p < 0.001). The number of nocturia episodes and the mean voided volume also improved, although there was no statistical significance. Efficacy did not differ between the 29 cases, with non-selective and non-selective drugs and 20 cases with non-selective and M3 selective drugs. Thirty-three (67.3%) patients reported to have benefited from combined medication. Maximal flow rate and post-void residual volume did not change in either of the sexes. Eleven (22.4%) patients discontinued the combination due to continued ineffectiveness and dry mouth. Conclusion: This retrospective study suggests that combined medication can help adults with refractory idiopathic OAB. Combined medication was tolerated in most of our patients.

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“…In fact, a preponderance of studies showed an improvement in efficacy and tolerability with extended-release formulations, especially with regard to dry mouth, a common adverse effect of antimuscarinics. [18][19][20][21][22][23] Likewise, some studies reported a greater adherence and persistence rate with the once-daily formulas. 5,24-25 Reinberg et al reported great tolerability and better efficacy with the extended-release forms of oxybutynin and tolterodine in children with diurnal urinary incontinence due to OAB.…”

Section: Discussionmentioning

confidence: 99%

Anticholinergic use in children: Persistence and patterns of therapy

Blais¹,

Bergeron²,

Nadeau³

et al. 2016

CUAJ

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Introduction: Overactive bladder (OAB) symptoms are complex and generally require long-term therapy. Nevertheless, it has been demonstrated that persistence rates of antimuscarinic drug use are low in adults. Better understanding of the treatment patterns of children treated with antimuscarinics could help to improve drug management. Our objective was to evaluate persistence rates of patients under 20 years of age on antimuscarinic therapy over a four-year period. Methods: Patients having received a first-ever antimuscarinic drug prescription between April 2007 and March 2008 were identified using IMS Brogan's Public and Private Drug Plans database. Canadian drug claims data from Private Drug Plans, Régie de l'Assurance Maladie du Québec, and Ontario Public Drug Plans were analyzed retrospectively. Patients were followed for four years to assess the prescribed drugs, the lines of treatment, and the duration of each treatment. Results: Data were available for 374 patients. The most prescribed drug as a first-line therapy was oxybutynin (87.2%), followed by tolterodine LA (5.9%). Patients refilled their index prescriptions for an average of 429 days. Solifenacin had the highest mean duration of index therapy (765 days). The median number of antimuscarinics prescribed was one. At the end of the followup, 44 patients were still on therapy. Reasons for discontinuation of treatment were not available. Conclusions: Overall discontinuation rate of antimuscarinic therapy in children is comparable to what has been reported in adult patients with OAB. However, children seem to persist on the medication for a longer duration before adherence rates start declining. The low rate of persistence highlights the need to identify the reasons for discontinuation of therapy in children in order to obtain better persistence rates.

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Tolterodine once-daily: superior efficacy and tolerability in the treatment of the overactive bladder

Cited by 432 publications

References 18 publications

Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients?

Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients?

Efficacy and tolerability of combined medication of two different antimuscarinics for treatment of adults with idiopathic overactive bladder in whom a single agent antimuscarinic therapy failed

Anticholinergic use in children: Persistence and patterns of therapy

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