A Study of Fesoterodine and Oxybutynin on Cognitive Function in Mild Cognitive Impairment

A Double Blind, Randomized Four Way Cross Over Study to Compare the Effect of Fesoterodine 4mg and 8mg Once Daily and Oxybutynin 5mg Twice Daily After Steady State Dosing Versus Placebo on Cognitive Function in Subjects With Overactive Bladder, Over the Age of 75 Years With Mild Cognitive Impairment

The purpose of this study is to assess the effects of fesoterodine at 4mg and 8mg doses versus a placebo and oxybutynin 5mg bid versus placebo on cognitive abilities in older people with overactive bladder and mild cognitive impairment.

Study Overview

• Status: Completed
• Conditions: Overactive Bladder; Mild Cognitive Impairment
• Intervention / Treatment: Drug: fesoterodine 4mg; Drug: Oxybutynin; Drug: placebo; Drug: fesoterodine 8mg

Detailed Description

This is a randomized placebo controlled, blinded four way cross over trial of the effect of medications used to treat overactive bladder on the cognition of older men and women with mild cognitive impairment. Each treatment phase is a week, with a weeks washout period before starting the next treatment. Cognitive testing is by way of a validated computer assisted battery of tests

• Study Type: Interventional
• Enrollment (Actual): 47
• Phase: Phase 2

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada, T6G 2P4
      • Division of Geriatric Medicine, Clinical Sciences Building, University of Alberta Hosp

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 75 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. The subject is either male or female and ≥ 75 years of age.
2. The subject has OAB as determined by ICS criteria
3. The subject has mild cognitive impairment as determined by NIA criteria
4. The subject is competent to give informed consent and perform the tasks associated with the study
5. The subject has a body mass index (BMI) between 18.0 to 30.0 kg/m2 inclusive.
6. Written informed consent has been obtained.
7. The subject is available to complete the study.
8. At training visits (visit 2): the subject has performed at or above the minimum level on at least one occasion for each individual task measure in cognitive function test training.

Exclusion Criteria:

1. The subject does not have OAB.
2. The subject has either dementia or moderate to severe cognitive impairment at screening.
3. The subject has probable clinical depression as determined by Geriatric Depression Scale (GDS) short form >5 at screening.
4. Subjects taking any cognitive enhancers (cholinesterase inhibitors or memantine).
5. The subject has a history of allergy to the study drug(s), to any component of the dosage form or any other allergy, which, in the opinion of the Investigator, contraindicates their participation.
6. The subject has any clinically significant abnormal heart rate or blood pressure measurements, at the screening visit, which, in the opinion of the Investigator, prevent safe participation in the study. (dBP< 60mmHg or > 90mmHg, sBP < 95mmHg or > 160mmHg or HR < 40bpm or > 100bpm).
7. Subjects with known history of urinary retention, severe gastrointestinal obstruction (including paralytic ileus or intestinal atony) or severe gastrointestinal conditions (including toxic megacolon or ulcerative colitis), myasthenia gravis, uncontrolled narrow angle glaucoma or shallow interior chamber or subjects deemed to be at risk for these conditions.
8. Subjects undergoing haemodialysis or who have severe renal impairment.
9. Subjects with severe hepatic impairment, defined as Child-Pugh grade IV.
10. Subjects taking potent CYP 3A4 inhibitors which would, under normal circumstances, require adjustment of the dose of the test drugs.
11. Subject has taken prescribed medication within 14 days prior to the first study day or over-the-counter medicine (including vitamins and herbal remedies) within 48 hours prior to the first study day, which in the opinion of the Investigator, will interfere with the study procedures or compromise safety.
12. Subject has an average weekly alcohol intake of greater than 21 units (male) or 14 units (female) within the 90 days prior to the study. 1 unit is 270cc of beer, 40cc of spirits or 125cc of wine.
13. History of smoking more than 10 cigarettes (or the equivalent amount of tobacco) per day within the 90 days prior to the study.
14. Subject has participated in any clinical study within the last 90 days.
15. Any clinically significant abnormality following Investigator review of the pre study physical examination.
16. Any clinical condition, which, in the opinion of the Investigator, would not allow safe completion of the study.
17. Any subjects who, in the opinion of the investigator, may find it difficult to adhere to the provisions of treatment and observation specified in the protocol.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Quadruple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Fesoterodine 4mg daily; fesoterodine 4mg oral	Drug: fesoterodine 4mg; 7 days therapy followed by seven days washout. Each 4mg tablet is taken in the morning; Other Names: Toviaz; Drug: Oxybutynin; 5mg IR oxybutynin taken bid, encapsulated into a form indistinguishable from placebo; Other Names: ditropan; Drug: placebo; placebo capsule, one twice daily, and 2 placebo fesoterodine tablets taken each morning for masking and comparator purposes; Other Names: placebo capsule; Drug: fesoterodine 8mg; 2, 4mg fesoterodine capsules taken together in the morning; Other Names: Toviaz 8mg
Experimental: Fesoterodine 8mg; Fesoterodine 8mg in form of 2, 4mg tablets	Drug: fesoterodine 4mg; 7 days therapy followed by seven days washout. Each 4mg tablet is taken in the morning; Other Names: Toviaz; Drug: Oxybutynin; 5mg IR oxybutynin taken bid, encapsulated into a form indistinguishable from placebo; Other Names: ditropan; Drug: placebo; placebo capsule, one twice daily, and 2 placebo fesoterodine tablets taken each morning for masking and comparator purposes; Other Names: placebo capsule; Drug: fesoterodine 8mg; 2, 4mg fesoterodine capsules taken together in the morning; Other Names: Toviaz 8mg
Active Comparator: oxybutynin; oxybutynin immediate release, encapsulated 2, 5mg capsules daily	Drug: fesoterodine 4mg; 7 days therapy followed by seven days washout. Each 4mg tablet is taken in the morning; Other Names: Toviaz; Drug: Oxybutynin; 5mg IR oxybutynin taken bid, encapsulated into a form indistinguishable from placebo; Other Names: ditropan; Drug: placebo; placebo capsule, one twice daily, and 2 placebo fesoterodine tablets taken each morning for masking and comparator purposes; Other Names: placebo capsule; Drug: fesoterodine 8mg; 2, 4mg fesoterodine capsules taken together in the morning; Other Names: Toviaz 8mg
Placebo Comparator: placebo capsule; placebo capsule, 2 per day	Drug: fesoterodine 4mg; 7 days therapy followed by seven days washout. Each 4mg tablet is taken in the morning; Other Names: Toviaz; Drug: Oxybutynin; 5mg IR oxybutynin taken bid, encapsulated into a form indistinguishable from placebo; Other Names: ditropan; Drug: placebo; placebo capsule, one twice daily, and 2 placebo fesoterodine tablets taken each morning for masking and comparator purposes; Other Names: placebo capsule; Drug: fesoterodine 8mg; 2, 4mg fesoterodine capsules taken together in the morning; Other Names: Toviaz 8mg

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
continuity of attention	Continuity of Attention: Accuracy of responding in Choice Reaction Time task Percent Target Detection in Digit Vigilance task False Alarms in Digit Vigilance task	1 and 4h post dose

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
cognitive function	includes the following domains of cognition; power of attention,; quality of working memory,; quality of episodic secondary memory,; speed of memory; Montreal Cognitive assessment score	1 and 4h post last dose of study drug

Collaborators and Investigators

• Sponsor: University of Alberta
• Collaborators: Pfizer
• Investigators: Principal Investigator: Adrian S Wagg, MD, University of Alberta

Publications and helpful links

General Publications

• Wagg A, Dale M, Tretter R, Stow B, Compion G. Randomised, multicentre, placebo-controlled, double-blind crossover study investigating the effect of solifenacin and oxybutynin in elderly people with mild cognitive impairment: the SENIOR study. Eur Urol. 2013 Jul;64(1):74-81. doi: 10.1016/j.eururo.2013.01.002. Epub 2013 Jan 11.
• Wesnes KA, Edgar C, Tretter RN, Bolodeoku J. Exploratory pilot study assessing the risk of cognitive impairment or sedation in the elderly following single doses of solifenacin 10 mg. Expert Opin Drug Saf. 2009 Nov;8(6):615-26. doi: 10.1517/14740330903260790.

Study record dates

Study Major Dates

• Study Start: August 1, 2016
• Primary Completion (Actual): January 31, 2020
• Study Completion (Actual): January 31, 2020

Study Registration Dates

• First Submitted: September 11, 2014
• First Submitted That Met QC Criteria: September 12, 2014
• First Posted (Estimate): September 15, 2014

Study Record Updates

• Last Update Posted (Actual): February 19, 2020
• Last Update Submitted That Met QC Criteria: February 18, 2020
• Last Verified: February 1, 2020

More Information

Terms related to this study

• Keywords: overactive bladder; placebo controlled; double blind; crossover study
• Additional Relevant MeSH Terms: Mental Disorders; Urologic Diseases; Urinary Bladder Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Neurocognitive Disorders; Cognition Disorders; Urinary Bladder, Overactive; Cognitive Dysfunction; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Parasympatholytics; Autonomic Agents; Peripheral Nervous System Agents; Muscarinic Antagonists; Cholinergic Antagonists; Cholinergic Agents; Urological Agents; Oxybutynin; Fesoterodine
• Other Study ID Numbers: FES-COG 1808