Superior efficacy of fesoterodine over tolterodine extended release with rapid onset: a prospective, head-to-head, placebo-controlled trial.

Abstract

OBJECTIVE:

• To show the superior efficacy of fesoterodine over tolterodine extended release (ER) in a placebo-controlled overactive bladder (OAB) trial with predefined treatment comparisons for both diary measures and patient-reported outcomes.

MATERIALS AND METHODS:

• In this 12-week, double-blind, double-dummy trial, subjects reporting >1 urgency urinary incontinence (UUI) episode and ≥8 micturitions per 24 h at baseline were randomized to fesoterodine (4 mg for 1 week, 8 mg for 11 weeks), tolterodine ER 4 mg, or placebo. • Subjects completed 3-day bladder diaries, the Patient Perception of Bladder Condition (PPBC) and the Urgency Perception Scale (UPS) at baseline and weeks 1, 4 and 12 and the OAB Questionnaire at baseline and week 12.

RESULTS:

• A total of 2417 subjects were randomized. At week 12, fesoterodine 8 mg showed superiority over tolterodine ER 4 mg and placebo on UUI episodes (primary endpoint), micturitions, urgency and most other diary endpoints, and on the PPBC, UPS and all OAB Questionnaire scales and domains (all P < 0.05). • Superiority of fesoterodine 8 mg over tolterodine ER 4 mg was seen as early as week 4 (3 weeks after escalation to fesoterodine 8 mg). At week 1, fesoterodine 4 mg was superior to placebo on most diary variables, the PPBC and the UPS (all P < 0.05). Dry mouth and constipation rates were 28% and 4% with fesoterodine, 13% and 3% with tolterodine ER, and 5% and 2% with placebo. • Discontinuation rates as a result of adverse events were 5%, 3% and 2% for fesoterodine, tolterodine ER and placebo, respectively.

CONCLUSIONS:

• In this randomized study, which is the largest to compare antimuscarinic efficacy performed to date, fesoterodine 8 mg was superior to tolterodine ER 4 mg for UUI episodes, micturitions and urgency episodes, as well as for self-reported patient assessments of bladder-related problems, urgency, symptom bother and health-related quality of life. • The superiority of fesoterodine 8 mg over tolterodine ER 4 mg was observed as early as 3 weeks after escalation from fesoterodine 4 mg for most outcomes. These data may have important implications for the clinical management of OAB patients previously treated with tolterodine ER.

• Authors: Steven A Kaplan, Tim Schneider, Jenelle E Foote, Zhonghong Guan, Martin Carlsson, Jason Gong
• Journal: BJU international (BJU Int) Vol. 107 Issue 9 Pg. 1432-40 (May 2011) ISSN: 1464-410X [Electronic] England
• PMID: 20860717 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.

Chemical References

• Benzhydryl Compounds
• Cresols
• Delayed-Action Preparations
• Muscarinic Antagonists
• Phenylpropanolamine
• Tolterodine Tartrate
• fesoterodine

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Benzhydryl Compounds (administration & dosage, therapeutic use)
• Cresols (administration & dosage, therapeutic use)
• Delayed-Action Preparations
• Epidemiologic Methods
• Female
• Humans
• Male
• Middle Aged
• Muscarinic Antagonists (administration & dosage, therapeutic use)
• Phenylpropanolamine (administration & dosage, therapeutic use)
• Quality of Life
• Tolterodine Tartrate
• Treatment Outcome
• Urinary Bladder, Overactive (complications, drug therapy)
• Urinary Incontinence, Urge (drug therapy, etiology)
• Young Adult