Effect of Electroacupuncture Versus PFMT Plus Solifenacin for Mixed Urinary Incontinence

Effect of Electroacupuncture Versus PFMT Plus Solifenacin for Moderate and Severe Mixed Urinary Incontinence in Female: a Multicenter, Noninferiority, Randomized Controlled Trial

A noninferiority randomized controlled trial aimed at comparing the effect and safety of electroacupuncture versus the pelvic floor muscle training (PFMT) plus solifenacin for mixed urinary incontinence (MUI).

Study Overview

• Status: Completed
• Conditions: Urinary Incontinence
• Intervention / Treatment: Procedure: acupuncture; Drug: solifenacin; Procedure: PFMT

Detailed Description

Participants experiencing mixed urinary incontinence will be recruited from 10 centers. A gynecologist or urologist will make the diagnosis. Central randomization will be performed by the Clinical Evaluation Center of the China Academy of Chinese Medical Sciences in Beijing.

Sample size: Sample size is based on the primary outcome. According to literature, the investigators predict that MUI patient's average 72-h incontinence episode frequency of the week 1-12 will decrease by 60% from the baseline after treatment of PFMT plus solifenacin. The number of the acupuncture group is 57%. For the assessment of noninferiority, 250 participants will be needed for each group allowing for a 15% dropout (α=0.05，β=0.2，δ=15%).

Quality control: A 3-level monitoring system (monitors responsible for one center, monitors responsible for all centers and monitors responsible for the whole trial) will be established to check the performance of the trial in time. Outcome assessment, completion of case report forms and data management will be under strict supervision.

Data management: The Remote Dara Capture (RDC) system will be used for data entering. Both paper and electronic case report form will be reserved. A data verification plan is made.

• Study Type: Interventional
• Enrollment (Actual): 500
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Beijing, China, 100053
    • Guang'an Men Hospotal Affiliated to China Academy of Chinese Medical Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 35 years to 75 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• females meet the meet the diagnostic criteria of mixed urinary incontinence
• aged 35-75 years
• moderate and severe urinary incontinence with the urinary incontinence severity index between 3 and 9
• suffering from urinary incontinence at least for 3 months with the 72-h incontinence episode frequency≥2 in the baseline assessment
• voluntarily join the research and sign the informed consent

Exclusion Criteria:

• pure stress urinary incontinence, pure urgency urinary incontinence, overflow incontinence and neurogenic bladder
• medicine use for urinary incontinence or may affect the bladder function, or taking any non-drug therapy (such as electric stimulation, bladder training and pelvic floor muscle training) in the last month
• symptomatic urinary tract infection and non-functional urologic disease
• having ever undergone an operation for urinary incontinence or on the pelvic floor (including hysterectomy)
• pelvic organ prolapse degree ≥2
• residual urinary volume (RUV) >30 mL
• maximum flow rate (Qmax) <20 mL/s;
• be allergic to solifenacin or having contradictions for muscarine antagonist (such as urinary retention, gastric retention, myasthenia gravis, ulcerative colitis and angle closure glaucoma)
• diseases affect function of lower urinary tract, such as uncontrolled diabetes, multiple sclerosis, Alzheimer's disease, Parkinson's disease, spinal injury, cauda equina injury and multiple system atrophy.
• serious cardiovascular, pulmonary, cerebral, liver, kidney, hematopoietic system or psychiatric disease and cognitive impairment
• patients with severe renal dysfunction or moderate hepatic dysfunction who are using strong Cyp3a4 Inhibitor like ketoconazole
• unable or limited to walking, up and down stairs and running
• poor compliance with electroacupuncture, pelvic floor muscle training or drug
• pregnancy, lactation or within the 12 months after birth
• having a cardiac pacemaker, a metal allergy, or a severe needle phobia.
• volunteer of other trials

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: acupuncture; BL33 and BL35 of both sides are used. Every session will last for 30 minuets and will be given every other day. There are 36 sessions for each participant in all (3 session per week, 12 weeks).	Procedure: acupuncture; For BL33, the needle (75mm) will be inserted at the point upper and outside of BL33. Insert the needle with a 30-45°angle to a depth of 50-60 mm. The needle will be manipulated with an even lifting, thrusting and twisting method and the sense of soreness and distention will radiate to the perineal region or the anus. For BL35, the needle will be inserted upward and outward slightly with an even lifting, thrusting and twisting method. The sense of soreness and distention will radiate to the perineal region or the anus. The electric stimulator will be put on the two pair of points with a spare-dense wave, 10/50 Hz, 0.1-5.0 mA. The current intensity will be increased until the participant can not stand.; Other Names: electroacupuncture
ACTIVE_COMPARATOR: Solifenacin plus PFMT; Both PFMT and solifenacin will be given for 36 weeks. Solifenacin will be taken 5mg once daily, before or after meal. PFMT includes intensive exercises conducted in hospital and home exercises. Intensive exercises will be done once every week for the first 12 weeks and once every four weeks for the 13th to 36th week. Home exercises will be done three times daily for 36 weeks.	Drug: solifenacin; Solifenacin used in this trial is produced by Astellas Pharma Europe B.V.(Country medicine accurate character No. J20090109 ); Other Names: competitive cholinergic receptor antagonist; Procedure: PFMT; Intensity of the PFMT exercises will conform to the guideline of National Institute for Health and Clinical Excellence (NICE).; Other Names: pelvic floor muscle training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Change From Baseline in 72-hour Incontinence Episode Frequency (IEF) Over Weeks 1-12	The average 72-h IEF is calculated based on a 72-h bladder diary. All relevant time points used in the calculation in the Time Frame (baseline, weeks 1-12)	baseline, weeks 1-12

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Change From Baseline in Mean 72-hour IEF During Weeks 13-24 and Weeks 25-36	Calculated as the same way as the primary outcome. But this outcome will be assessed at different time point.	baseline, weeks 13-24, week 25-36
Percentage of Participants With ≥50% Decrease in Average 72-h Incontinence Episode Frequency	Count the number of cases with the reduction of average 72-h incontinence episode frequency ≥50% and divide it by the number of participants at baseline.	Weeks 1-12, 13-24, 25-36
Change of Episodes From Baseline in Average 72-hour Urgencies/Urination/Nocturia Episodes	The average 72-h IEF (urinary incontinence, stress urinary incontinence and urgency urinary incontinence respectively) is calculated based on a 72-h bladder diary. For example, the average 72-h incontinence episodes from the 13th to 36th week equal to the sum of 72-h incontinence episodes of the 16th, 20th, 24th, 28th, 32nd, 36th weeks divided by 6.	Baseline, weeks 1-12, 13-24, 25-36
Change From Baseline in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) Score	The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF (range, 0 [best]-21 [worst] outcomes, and 2.52 as minimal clinically important differences (MCID)) scores.	baseline, weeks 12, 24 and 36
Weekly Median Number of Urine Pads Used During Weeks 1-12, 13-24, and 25-36		Baseline, weeks 1-12, 13-24, 25-36
the Amount of Urine Leakage (Grams) Measured by the 1-hour Pad Test at Weeks 4 and 12	The performance of 1-hour pad test according to the International Incontinence Society: Participants were instructed to void 2 hours before the pad test. On arrival, they received a pre-weighed pad and were asked to sit and drink 500 ml sodium-free water in 15 minutes. Next, they were instructed to walk for 30 minutes, including going up and down 24 stairs. On returning to the clinic, the participants were instructed to perform several activities, including standing and sitting 10 times, coughing vigorously 10 times, running for 1 minute, picking up a coin from the floor 5 times, and putting their hands under water for 1 minute. After the activities were completed, the pad was reweighed to measure the amount of urinary leakage using a gram sensitive weight scale (Xiangshan, EK3820).	Weeks 4 and 12
Patient's Treatment Satisfaction Degree	The self-assessing satisfaction degree on a 5-point Likert scale (range, 1 [unsatisfied strongly] to 5 [satisfied strongly]) will be finished by participants to evaluate their satisfaction for the treatment.	Weeks 12, 36
Patient Global Impression Improvement	Participants will be asked to finish one item evaluating their present condition.	Weeks 12, 36
Electroacupuncture Acceptance Assessment	The acceptance of electroacupuncture will be tested within 5 minute with a 5-point scale ('0' means very difficult to accept and '4' means accept easily). Median of scores of the three times will be calculated.	Weeks 2, 6 and 12
The Number of Participants Using Urine Pads		Weeks 1-12, 13-24, 25-36
Change of Episodes From Baseline in Mean 72-h Incontinence Episodes		Weeks 1-12, 13-24, 25-36

Collaborators and Investigators

• Sponsor: Guang'anmen Hospital of China Academy of Chinese Medical Sciences
• Investigators: Study Director: Zhishun Liu, doctor, Guang'an Men Hospotal Affiliated to China Academy of Chinese Medical Sciences

Publications and helpful links

General Publications

• Sun B, Liu Y, Su T, Sun Y, Liu Z. Electroacupuncture for stress-related urinary incontinence in elderly women: data analysis from two randomised controlled studies. BMJ Support Palliat Care. 2022 May;12(e1):e164-e170. doi: 10.1136/bmjspcare-2019-002034. Epub 2020 Jan 9.
• Hargreaves E, Baker K, Barry G, Harding C, Zhang Y, Kandala NB, Zhang X, Kernohan A, Clarkson CE. Acupuncture for treating overactive bladder in adults. Cochrane Database Syst Rev. 2022 Sep 23;9(9):CD013519. doi: 10.1002/14651858.CD013519.pub2.
• Liu B, Liu Y, Qin Z, Zhou K, Xu H, He L, Li N, Su T, Sun J, Yue Z, Zang Z, Zhang W, Zhao J, Zhou Z, Liu L, Wu D, Wu J, Zhou J, Pang R, Wang Y, Liu J, Yu J, Liu Z. Electroacupuncture Versus Pelvic Floor Muscle Training Plus Solifenacin for Women With Mixed Urinary Incontinence: A Randomized Noninferiority Trial. Mayo Clin Proc. 2019 Jan;94(1):54-65. doi: 10.1016/j.mayocp.2018.07.021.
• Liu B, Wang Y, Xu H, Chen Y, Wu J, Mo Q, Liu Z. Effect of electroacupuncture versus pelvic floor muscle training plus solifenacin for moderate and severe mixed urinary incontinence in women: a study protocol. BMC Complement Altern Med. 2014 Aug 15;14:301. doi: 10.1186/1472-6882-14-301.

Study record dates

Study Major Dates

• Study Start: April 1, 2014
• Primary Completion (ACTUAL): August 1, 2016
• Study Completion (ACTUAL): October 1, 2016

Study Registration Dates

• First Submitted: January 23, 2014
• First Submitted That Met QC Criteria: January 25, 2014
• First Posted (ESTIMATE): January 28, 2014

Study Record Updates

• Last Update Posted (ACTUAL): June 6, 2019
• Last Update Submitted That Met QC Criteria: March 3, 2019
• Last Verified: March 1, 2019

More Information

Terms related to this study

• Keywords: electroacupuncture; urinary incontinence; Solifenacin; PFMT
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Urologic Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Urination Disorders; Elimination Disorders; Urinary Incontinence; Enuresis; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Muscarinic Antagonists; Cholinergic Agents; Urological Agents; Solifenacin Succinate; Cholinergic Antagonists
• Other Study ID Numbers: 2012BAI24B01-MUI

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO