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Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: a double-blind, placebo controlled trial.
J Urol. 2014 02; 191(2):395-404.JU

Abstract

PURPOSE

We evaluated the efficacy and safety of flexible dose fesoterodine in medically complex vulnerable elderly subjects with urgency urinary incontinence.

MATERIALS AND METHODS

In this 12-week, randomized, double-blind, flexible dose, placebo controlled trial, subjects were community dwelling men and women 65 years old or older. Subjects had scores of 3 or more on the VES-13 (Vulnerable Elders Survey) and 20 or more on the MMSE (Mini-Mental State Examination), and 2 to 15 urgency urinary incontinence episodes and 8 or more micturitions per 24 hours on 3-day baseline diaries. Subjects randomized to fesoterodine received 4 mg once daily for 4 weeks and could then increase to 8 mg based on discussion with the investigator. Subjects receiving 8 mg could decrease the dose to 4 mg at any time (sham escalation and de-escalation for placebo). The primary outcome measure was change in daily urgency urinary incontinence episodes. Secondary outcomes included changes in other diary variables and patient reported quality of life measures. Safety evaluations included self-reported symptoms and post-void residual volume.

RESULTS

A total of 562 patients were randomized (mean age 75 years, 50.4% age 75 years or greater). Subjects had high rates of comorbidities, polypharmacy and functional impairment. At week 12 the fesoterodine group had significantly greater improvements in urgency urinary incontinence episodes per 24 hours (-2.84 vs -2.20, p = 0.002) and most other diary variables and quality of life, as well as a higher diary dry rate (50.8% vs 36.0%, p = 0.002). Adverse effects were generally similar to those of younger populations including risk of urinary retention.

CONCLUSIONS

To our knowledge this is the first antimuscarinic study in a community based, significantly older, medically complex elderly population with urgency urinary incontinence. Flexible dose fesoterodine significantly improved urgency urinary incontinence episodes and other outcomes vs placebo, and was generally well tolerated.

Authors+Show Affiliations

University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, Massachusetts. Electronic address: Catherine.DuBeau@umassmemorial.org.University of Texas Health Science Center at San Antonio, San Antonio, Texas.University of Kansas, Kansas City, Kansas.University of Pennsylvania, Philadelphia, Pennsylvania.University of Minnesota, Minneapolis, Minnesota.Atlanta VA Medical Center and Emory University, Atlanta, Georgia.Florida Atlantic University, Boca Raton, Florida.Pfizer Inc, New York, New York.Pfizer Inc, New York, New York.Pfizer Inc, New York, New York.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23973522

Citation

Dubeau, Catherine E., et al. "Effect of Fesoterodine in Vulnerable Elderly Subjects With Urgency Incontinence: a Double-blind, Placebo Controlled Trial." The Journal of Urology, vol. 191, no. 2, 2014, pp. 395-404.
Dubeau CE, Kraus SR, Griebling TL, et al. Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: a double-blind, placebo controlled trial. J Urol. 2014;191(2):395-404.
Dubeau, C. E., Kraus, S. R., Griebling, T. L., Newman, D. K., Wyman, J. F., Johnson, T. M., Ouslander, J. G., Sun, F., Gong, J., & Bavendam, T. (2014). Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: a double-blind, placebo controlled trial. The Journal of Urology, 191(2), 395-404. https://doi.org/10.1016/j.juro.2013.08.027
Dubeau CE, et al. Effect of Fesoterodine in Vulnerable Elderly Subjects With Urgency Incontinence: a Double-blind, Placebo Controlled Trial. J Urol. 2014;191(2):395-404. PubMed PMID: 23973522.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: a double-blind, placebo controlled trial. AU - Dubeau,Catherine E, AU - Kraus,Stephen R, AU - Griebling,Tomas L, AU - Newman,Diane K, AU - Wyman,Jean F, AU - Johnson,Theodore M,2nd AU - Ouslander,Joseph G, AU - Sun,Franklin, AU - Gong,Jason, AU - Bavendam,Tamara, Y1 - 2013/08/21/ PY - 2013/08/13/accepted PY - 2013/8/27/entrez PY - 2013/8/27/pubmed PY - 2014/4/15/medline KW - AEs KW - HRQL KW - OAB KW - PVR KW - UUI KW - VE KW - adverse events KW - fesoterodine KW - health related quality of life KW - muscarinic antagonists KW - overactive KW - overactive bladder KW - post-void residual urinary volume KW - urge KW - urgency urinary incontinence KW - urinary bladder KW - urinary incontinence KW - vulnerable elderly KW - vulnerable populations SP - 395 EP - 404 JF - The Journal of urology JO - J Urol VL - 191 IS - 2 N2 - PURPOSE: We evaluated the efficacy and safety of flexible dose fesoterodine in medically complex vulnerable elderly subjects with urgency urinary incontinence. MATERIALS AND METHODS: In this 12-week, randomized, double-blind, flexible dose, placebo controlled trial, subjects were community dwelling men and women 65 years old or older. Subjects had scores of 3 or more on the VES-13 (Vulnerable Elders Survey) and 20 or more on the MMSE (Mini-Mental State Examination), and 2 to 15 urgency urinary incontinence episodes and 8 or more micturitions per 24 hours on 3-day baseline diaries. Subjects randomized to fesoterodine received 4 mg once daily for 4 weeks and could then increase to 8 mg based on discussion with the investigator. Subjects receiving 8 mg could decrease the dose to 4 mg at any time (sham escalation and de-escalation for placebo). The primary outcome measure was change in daily urgency urinary incontinence episodes. Secondary outcomes included changes in other diary variables and patient reported quality of life measures. Safety evaluations included self-reported symptoms and post-void residual volume. RESULTS: A total of 562 patients were randomized (mean age 75 years, 50.4% age 75 years or greater). Subjects had high rates of comorbidities, polypharmacy and functional impairment. At week 12 the fesoterodine group had significantly greater improvements in urgency urinary incontinence episodes per 24 hours (-2.84 vs -2.20, p = 0.002) and most other diary variables and quality of life, as well as a higher diary dry rate (50.8% vs 36.0%, p = 0.002). Adverse effects were generally similar to those of younger populations including risk of urinary retention. CONCLUSIONS: To our knowledge this is the first antimuscarinic study in a community based, significantly older, medically complex elderly population with urgency urinary incontinence. Flexible dose fesoterodine significantly improved urgency urinary incontinence episodes and other outcomes vs placebo, and was generally well tolerated. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/23973522/Effect_of_fesoterodine_in_vulnerable_elderly_subjects_with_urgency_incontinence:_a_double_blind_placebo_controlled_trial_ L2 - https://www.jurology.com/doi/10.1016/j.juro.2013.08.027?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -