Exploring Predictors of Symptoms Relapse After Discontinuation of Treatment in Overactive Bladder (OAB) Patients

Exploring Predictors of Symptoms Relapse After Discontinuation of Successful Treatment With a Tolterodine Prolonged Release Capsules (4 mg, Once Daily) in Overactive Bladder Patients: A Prospective Randomized Multicenter Trial

This is a Phase IV, prospective, randomized, multi-center study to find risk factors of OAB symptoms relapse in patients who showed therapeutic benefits after 1, 3, or 6 months of treatment with Tolterodine SR and who then discontinued these antimuscarinics for 3 month.

Patients who have OAB symptoms for 6 or more than 6 months and who show successful treatment response to 1 month of treatment with Tolterodine SR 4mg will be enrolled and randomized to 1, 3 or 6 months of treatment group. After completion of the treatment, subjects will be evaluated for changes in OAB symptoms and retreatment rate will be assessed.

Study Overview

• Status: Completed
• Conditions: Overactive Bladder
• Intervention / Treatment: Drug: Tolterodine; Drug: Tolterodine; Drug: Tolterodine 6

Detailed Description

Primary Objective:

• To investigate the risk factors of OAB symptom relapse and retreatment in patients who showed therapeutic benefits after 1, 3 or 6 months of treatment with Tolterodine SR and who then discontinued these antimuscarinics for 3 month.

Secondary Objective:

• To investigate the change of the patient perception and quality of life after antimuscarinic discontinuation
• To find the rate of patients who have OAB symptom relapse.
• To find the risk factors of patients who want retreatment.
• To find the rate of patients who want retreatment.

• Study Type: Interventional
• Enrollment (Actual): 173
• Phase: Phase 4

Contacts and Locations

Study Locations

• Korea, Republic of
  • Gyeonggi-do, Korea, Republic of
    • Holy Family Hospital, The Catholic University of Korea
  • Seoul, Korea, Republic of
    • Seoul National University Hospital
  • Seoul, Korea, Republic of
    • Asan Medical Center, Ulsan College of Medicine
  • Seoul
    • Irwon-dong, Seoul, Korea, Republic of, 135-710
      • Samsung Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 76 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

1. Female aged 18≤and ≤80 years
2. Symptoms of urinary urgency (defined as a level of 3 to 5 in a 5 point Urinary Sensation Scale) over 2 times per day
3. Symptoms of urinary frequency (≥ 8 micturitions per 24 hours) as verified by baseline micturition diary.
4. Symptoms of overactive bladder, including urinary urge incontinence, urgency and/or frequency for ≥6 months.
5. Ability and willingness to correctly complete the micturition diary and questionnaire
6. Capable of understanding and having signed the informed consent form after full discussion of the research nature of the treatment and its risks and benefits

Exclusion Criteria:

1. Clinical significant stress incontinence as determined by the investigator and confirmed for female patients by a cough provocation test
2. An average volume voided of > 200 ml per micturition as verified on the baseline micturition diary
3. Total daily urine volume of > 3000 ml as verified on the baseline micturition diary
4. Significant hepatic or renal disease, defined as having twice the upper limit of the reference ranges for serum concentrations of aspartate aminotransferase (AST [SGOT]), alanine aminotransferase (ALT [SGPT]), alkaline phosphatase or creatinine
5. Any condition that is a contraindication for anticholinergic treatment, including uncontrolled narrow-angled glaucoma, urinary retention or gastric retention
6. Symptomatic acute urinary tract infection (UTI) during the run-in period
7. Recurrent UTIs defined as having been treated for symptomatic UTIs > 4 times in the last year
8. Diagnosed or suspected interstitial cystitis
9. Uninvestigated hematuria or hematuria secondary to malignant disease.
10. Clinically significant bladder outlet obstruction defined by clinical symptoms and investigator's opinion according to local standard of care
11. Patients with marked cystocele or other clinically significant pelvic prolapse.
12. On an unstable dosage of any drug with anticholinergic side effects, or expected to start such treatment during the study
13. Receipt of any electrostimulation or bladder training within the 14 days before the start of tolterodine SR, or expected to start such treatment during the study
14. Use of any other drugs for the treatment of overactive bladder (e.g. anticholinergics except tolterodine) within the 14 days before the start of tolterodine SR, or expected to start such treatment during the study
15. An indwelling catheter or practicing intermittent self-catheterization
16. Use of any investigational drug within 2 months preceding the start of the study
17. Patients with chronic constipation or history of severe constipation
18. Pregnant or nursing women
19. Sexually active females of childbearing potential not using reliable contraception for at least 1 month prior to study start and not agreeing to use such methods during the entire study period and for at least 1 month thereafter. Reliable contraceptive methods are defined as intrauterine devices (IUDs), combination type contraceptive pills, hormonal implants, double barrier method, injectable contraceptives and surgical procedures (tubal ligation or vasectomy).
20. Patients who have bladder cancer
21. Treatment with potent CYP3A4 inhibitors, such as cyclosporine, vinblastine, macrolide antibiotics (e.g. erythromycin, clarithromycin, azithromycin) or antifungal agents (e.g. ketoconazole, itraconazole, micronazole).
22. Any other condition which, in the opinion of the investigator, makes the patient unsuitable for inclusion

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Tolterodine 1	Drug: Tolterodine; Extended release tolterodine tartrate 4 mg, once daily, for 1 months; Other Names: Detrusitol ER 4mg; Drug: Tolterodine; Extended release tolterodine tartrate 4 mg, once daily, for 3 months; Other Names: Detrusitol ER 4mg
Experimental: Toterodine 3	Drug: Tolterodine; Extended release tolterodine tartrate 4 mg, once daily, for 1 months; Other Names: Detrusitol ER 4mg; Drug: Tolterodine; Extended release tolterodine tartrate 4 mg, once daily, for 3 months; Other Names: Detrusitol ER 4mg
Experimental: Tolterodine 6	Drug: Tolterodine 6; Extended release tolterodine tartrate 4 mg, once daily, for 6 months; Other Names: Detrusitol ER 4mg

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Risk factors and relapse rate of the OAB symptoms after drug discontinuation	from baseline (treatment completion) to 1, 3 month after drug discontinuation

Secondary Outcome Measures

Outcome Measure	Time Frame
Micturition diary efficacy parameters	from baseline (treatment completion) to 1, 3 month after drug discontinuation
Quality of life parameters: change in total score and subscale scores of OAB-questionnaire	from baseline (treatment completion) to 1, 3 month after drug discontinuation
Patient perceptions: change in patient perception of urgency, change in patient perception of bladder condition and percentage of patients who wants retreatment	from baseline (treatment completion) to 1, 3 month after drug discontinuation

Collaborators and Investigators

• Sponsor: KYU-SUNG LEE
• Collaborators: Pfizer

Study record dates

Study Major Dates

• Study Start: August 1, 2006
• Primary Completion (Actual): July 1, 2009
• Study Completion (Actual): July 1, 2009

Study Registration Dates

• First Submitted: August 7, 2008
• First Submitted That Met QC Criteria: August 7, 2008
• First Posted (Estimate): August 8, 2008

Study Record Updates

• Last Update Posted (Actual): December 2, 2019
• Last Update Submitted That Met QC Criteria: November 28, 2019
• Last Verified: April 1, 2011

More Information

Terms related to this study

• Keywords: Overactive bladder, Tolterodine,Symptoms Relapse, Predictor
• Additional Relevant MeSH Terms: Pathologic Processes; Urologic Diseases; Urinary Bladder Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Disease Attributes; Urinary Bladder, Overactive; Recurrence; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Muscarinic Antagonists; Cholinergic Antagonists; Cholinergic Agents; Urological Agents; Tolterodine Tartrate
• Other Study ID Numbers: 2005-08-069