Effectiveness of Bryophyllum in Nocturia-Therapy

Effectiveness of Bryophyllum Pinnatum by Patients With Nocturia and Its Effect on Sleep Quality

Night-time micturition, called nocturia, is a very common problem that unfavourably influences sleep- and life-qualities. The International Continence Society (ICS) defines nocturia as micturition once or several times during the night. Nocturia is one of the cardinal symptoms of overactive bladder (OAB). Persons with nocturia have the intention to continue sleep after going to the toilet which does not succeed to the same extent, depending on age.

The natural occurrence of the plant, Bryophyllum pinnatum (BP) which is used in this observational study origins from Madagascar as well as in tropical Africa, South America and Asia. In the folk medicine of these countries BP is widely used. BP has a calming, spasmolytic, anti-inflammatory, pain-relieving, diuretic and cytotoxic effects.

According to previous preclinical and clinical studies the inhibiting effect of BP on overactive bladder was proven. The pharmacological effect of this plant on uterine smooth muscle cells, on spontaneous and oxytocin-stimulated contractions, and on detrusor muscle cells in an in-vitro model of the pig's bladder was shown. Smooth muscle relaxation is not only required for preventing premature labour but also for symptom's relief of overactive bladder (OAB). The flavonoid, aglycons and bufadienolides, are components of the pressed juice of the BP leaves that have comparable effects to the standard drug oxybutynin on vesical smooth muscle cells.

Since many year BP is used in obstetrics not only as tocolytics but also as a sedative and sleeping pill.

There are known only few adverse events, such as skin irritation by intravenous application.

The interest in phytotherapeutical drugs for treatment the chronic diseases is very high and Bryophyllum is also frequently used in Switzerland for hyperactive conditions.

In Switzerland, following the vote on complementary medicine on 17.05.2009, alternative treatments will be covered by basic health insurance. Definitive inclusion in the catalogue of benefits will be granted if effectiveness, safety and cost-effectiveness can be demonstrated.

The potential and side-effect profile of BP, as well as the social interest in research into alternative methods is the background to the implementation of this observational study.

Study Overview

• Status: Completed
• Conditions: Sleep Disorder; Nocturia
• Intervention / Treatment: Drug: Bryophyllum pinnatum 50 %, tablets into capsules (verum: 2x2capsules/day)

Detailed Description

In the therapeutic concept of the treatment of OAB, antimuscarinic drugs play a central role. Antimuscarinics are known to inhibit the contraction of detrusor muscle (smooth muscle cells) and block the muscarinic receptor (M2/M3) important for efferent nerve conduction. This conventional therapy for OAB can have important adverse effects, notably on the gastrointestinal tract with constipation, on the excretory glands in the sense of xerostomia/xerophthalmia, on the nerve cells of the brain inhibiting cognitive function and in the heart muscle cells accelerating the heart rate. Especially elderly people are affected by these undesirable effects. Because of changes in the receptor profile, the effect of antimuscarinics and improvement of symptoms might be lowered in elderly people and another substance with less side effects would be of great interest. No such adverse effects are reported for B. pinnatum. Until now, there are few data for its use in OAB. Efficacy and tolerability of B. pinnatum in the treatment of OAB are the major outcome measures of this clinical trial.

• 50 women are included in this observational study, treated with Bryophyllum pinnatum in form of the commercially available Bryophyllum tablets into capsules (verum: 2x2capsules/day). Recruitment time is planned from January, 2018 to January 2022.
• Duration of the drug administration is 3 weeks.
• Primary endpoint are the reduction of nocturia (measured by filling in a voiding dairy) and the change of sleep-quality (measured by using Pittsburgh Sleep Quality Index)
• secondary endpoints are the improvement of quality of life (measured by using the King's Health Questionnaire and the International Consultation on Incontinence Overactive Bladder Questionnaire (ICIQ-OAB), two questionnaires, validated for the German language and for women with incontinence), increase of the micturition volumes and reduction of urge episodes (measured by the patients and recorded in a voiding dairy) and the registration of adverse events during the study phase. Ethics committee approval has been given.

• Study Type: Interventional
• Enrollment (Actual): 50
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Zurich, Switzerland, 8091
    • University of Hospital, Clinic for Gynecology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Nocturia ≥2 Mal per a night
• Overactive bladder (>8 Mictions/day)
• Age > 18 Years
• local or systemic Therapy with Estrogen, if the therapy dates >4 Weeks before study-start.
• prior incontinence operation (if the operation dates back more than 6 months)
• german speaking Patients and a given informed consent

Exclusion Criteria:

• Intolerance against a substance or a compound
• participation in an other study 4 weeks prior to inclusion
• urinary tract infection
• drug abuse
• bladder affecting drugs like anticholinergics, diuretics, muscle relaxing medicaments and phytotherapeutics
• lactose intolerance
• Pregnant and lactating women
• Incompliance of Patient

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Bryophyllum pinnatum; Bryophyllum pinnatum (BP) muscle relaxing substance	Drug: Bryophyllum pinnatum 50 %, tablets into capsules (verum: 2x2capsules/day); Bryophyllum is administered for 3 weeks. Bryophyllum is given in form of capsules, 350mg per capsule, 0-0-2-2/d: 2 capsules 30min. before supper,2 capsules before going to bed. Other Names: Bryophyllum pinnatum/Kalanchoe

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduction of nocturia frequency	micturition protocol will be handed over during the baseline visit, it will be filled three days before the second visit in 1 week( therapy-start), follow-up control 3 weeks after medication intake and after the completed medication period ]	4 Weeks
Sleep-Quality.	Pittsburgh Sleep Quality Index (PSQI; score 0-21) will be handed over during the baseline visit and will be filled three days before the second visit in 1 Week and three days after the therapy-end (after 3 Weeks). The global PSQI score is then calculated by totaling the seven component scores, providing an overall score ranging from 0 to 21, where lower scores denote a healthier sleep quality.	4 Weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes of overactive bladder symptoms	quality of life is measured by the ICIQ-OAB (score 0-16), a specific questionnaire for OAB	before the second visit in 1 week, at follow-up control 3 weeks after begin of medication intake and 4 weeks after end of medication intake.
Safety of Bryophyllum: adverse events	during medication intake at 1 week and 3 weeks after start of medication intake, measured by a personal adverse event protocol	4 weeks
Daytime sleepiness	quality of life is measured by Epworth Sleepiness Scale Questionnaire (score 0-24)	before the second visit in 1 week, at follow-up control 3 weeks after begin of medication intake and 4 weeks after end of medication intake.

Collaborators and Investigators

• Sponsor: University of Zurich

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2018
• Primary Completion (Actual): February 18, 2021
• Study Completion (Actual): January 14, 2022

Study Registration Dates

• First Submitted: July 13, 2020
• First Submitted That Met QC Criteria: July 20, 2020
• First Posted (Actual): July 21, 2020

Study Record Updates

• Last Update Posted (Actual): January 19, 2022
• Last Update Submitted That Met QC Criteria: January 16, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Nervous System Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Neurologic Manifestations; Sleep Wake Disorders; Nocturia
• Other Study ID Numbers: 2017-01964

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Sharing Supporting Information Type: Clinical Study Report (CSR)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No