- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05806164
Beta-Agonist Versus OnabotulinumtoxinA Trial for Urgency Urinary Incontinence (BEST)
The goal of this clinical trial is to compare treatment outcomes between an oral medication (beta agonist) versus onabotulinumtoxinA injections in women with urgency urinary incontinence (UUI).
Participants will be randomly selected to receive one of the two treatments. The primary outcome measure will be at 3 months, and women will be followed for a total of 12 months.
Based on patient expert input, there are 2 primary outcomes: Treatment satisfaction and urinary symptom severity.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The purpose of this study is to directly compare 2 primary outcomes (Treatment satisfaction and urinary symptom severity) between beta agonist oral medication versus onabotulinumtoxinA intradetrusor bladder injection for the treatment of UUI.
The study will also compare secondary outcomes identified as important by patients. At the end of the study, the investigators will have patient and stakeholder-derived comparative outcomes between these 2 commonly available treatment categories. A stakeholder and community engagement (CE) plan will be developed and implemented. The investigators will also develop a model to help guide patients and providers through this decision process.
SPECIFIC AIMS Specific Aim 1: Compare the efficacy of beta agonist versus onabotulinumtoxinA on patient-important treatment outcomes at 3 months in women with UUI.
This multi-center, randomized clinical trial (RCT) includes 5 sites across the U.S. Two co-primary outcomes will be measured using validated patient-reported outcomes (PROs), selected by patients: Co-primary outcome 1: Symptom severity, measured by change in Overactive Bladder Questionnaire-Symptom Bother Scale (OAB-q-SS) score.
Co-primary outcome 2: Treatment satisfaction, measured by the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General (FACIT-TS-G), powered based on a single item.
Specific Aim 2: Compare secondary patient-important outcomes. Direct comparisons between intervention effects on secondary outcomes chosen by patients and stakeholders, including adverse events, UUI quality of life, global improvement, and sexual function.
Specific Aim 3: Use predictive modeling to help stakeholders better determine expected outcomes after treatment with beta agonist versus onabotulinumtoxinA.
Comparators: Beta agonist oral medication (mirabegron or vibegron) versus intradetrusor onabotulinumtoxinA.
Both beta-agonists and onabotulinumtoxinA are US Food and Drug Administration (FDA) approved for the treatment of UUI, and widely available options with established efficacy.
432 women will be randomly assigned to each treatment option: 216 to beta agonist oral medication and 216 to intradetrusor onabotulintoxinA. Women will be undergo outcomes assessments at 3, 6, 9, and 12 months. The primary outcome measure will be at 3 months.
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Ann Meers, BS, RN
- Phone Number: 48228 401-274-1100
- Email: Ameers@wihri.org
Study Contact Backup
- Name: Sara Veera, BS
- Phone Number: 48222 401-274-1100
- Email: sveera@wihri.org
Study Locations
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Alabama
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Birmingham, Alabama, United States, 35233
- Recruiting
- University of Alabama at Birmingham
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Contact:
- Sunita Patel
- Phone Number: 205-996-0241
- Email: sunitapatel@uabmc.edu
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Principal Investigator:
- Holly Richter, PhD, MD
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California
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San Diego, California, United States, 92093
- Recruiting
- University of California, San Diego
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Principal Investigator:
- Emily Lukacz, MD
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Contact:
- Kyle Herrala
- Phone Number: 858-657-6827
- Email: UrogynRSCH@ucsd.edu
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District of Columbia
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Washington, District of Columbia, United States, 20059
- Recruiting
- Howard University
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Contact:
- Angela Silva
- Email: asilva@thecpin.com
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Principal Investigator:
- Tatiana Sanses, MD
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New Mexico
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Albuquerque, New Mexico, United States, 87131
- Recruiting
- University of New Mexico
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Contact:
- Karen Taylor
- Phone Number: 505-205-4118
- Email: Kataylor@salud.unm.edu
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Contact:
- Cassandra Darley
- Email: cjdarley@salud.unm.edu
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Principal Investigator:
- Peter Jeppson, MD
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Rhode Island
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Providence, Rhode Island, United States, 02905
- Recruiting
- Women & Infants Hospital of Rhode Island
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Contact:
- Ann Meers, BS, RN
- Phone Number: 48228 401-274-1100
- Email: Ameers@wihri.org
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Contact:
- Sara Veera, BS
- Phone Number: 48222 401-274-1100
- Email: sveera@wihri.org
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion criteria*:
- 18 years or older
- report at least "quite a bit bothered" or worse by their UUI defined by response to OAB-q-SS item #8 "How bothered are you by urine loss associated with a strong desire to urinate?"
- are not and do not plan to become pregnant
- have persistent UUI defined as previous unsuccessful results after conservative and anticholinergic treatment, or are unable to tolerate or have contraindications to anticholinergics
- are currently not taking anticholinergics or are willing to stop medication for 3 weeks prior to enrollment.
- for participants reporting mixed urinary incontinence symptoms, participant must (a) have less bother from SUI than from UUI, defined as a response of "Not at all bothered" or only "a little bit bothered" by SUI on the Urogenital Distress Inventory item "Do you experience urine leakage related to physical activity? (walking, running, laughing, sneezing, coughing), and (b) SUI symptoms be stable (> 3 months), and (c)participant does not desire additional treatment for SUI in the upcoming 3 months.
- Participants after unsuccessful neuromodulation trial can be eligible after a 4-week washout period.
Exclusion criteria:
- clinical contraindication to beta-3 agonist or onabotulinumtoxinA
- prior therapeutic trial of either study treatment
- unevaluated hematuria, current or prior bladder malignancy
- surgically altered detrusor muscle
- prior pelvic radiation
- post-void residual >150 mL in past 3 months
- neurogenic bladder
- pelvic floor surgery within the past 3 months
- anticipating pelvic surgery within primary outcome follow up period (3 months)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Intradetrusor onabotulinumtoxinA
OnabotulinumtoxinA at a dose of 100 units will be injected into the bladder per usual care pathways.
|
OnabotulinumtoxinA will be prepared by dissolving 100 units into 10 ml of injectable saline.
The injection will be an office based procedure, performed per usual care.
Other Names:
|
Active Comparator: Beta-3 receptor agonist oral medication
Selective beta-3 receptor agonist oral medication approved for the treatment of urgency urinary incontinence including mirabegron or vibegron.
Usual clinical care standards will be used for prescribing and dosing changes.
For mirabegron, dosages are 25 mg and 50 mg as clinically indicated.
For vibegron, dosage is 75 mg daily by mouth as clinically indicated.
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The beta-agonist oral medication will be prescribed and dose adjusted per usual care.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in score Overactive Bladder Questionnaire-Symptom Bother Scale (OAB-q-SS) at 3 months
Time Frame: Baseline until 3 months
|
8-item questionnaire measuring symptom bother of overactive bladder symptoms, higher scores indicate more bothersome symptoms
|
Baseline until 3 months
|
Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General Questionnaire (FACIT-TS-G) at 3 months
Time Frame: 3 months
|
Single item "How do you rate this treatment overall" on a 5-point likert scale
|
3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Overactive Bladder Questionnaire-Symptom Bother Scale (OAB-q-SS)
Time Frame: Baseline until 6, 9, 12 months
|
8-item questionnaire measuring symptom bother of overactive bladder symptoms
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Baseline until 6, 9, 12 months
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Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General Questionnaire (FACIT-TS-G) at 3 months
Time Frame: 6, 9, 12 months
|
8-item questionnaire assessing treatment satisfaction of adults undergoing treatment for chronic conditions
|
6, 9, 12 months
|
Change in Overactive Bladder Questionnaire-Health Related Quality of Life (OAB-q-HRQL)
Time Frame: Baseline to 3, 6, 9, 12 months
|
Overactive bladder disease specific questionnaire measuring quality of life, higher scores indicate better HRQL
|
Baseline to 3, 6, 9, 12 months
|
Change in Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-IR)
Time Frame: Baseline to 3, 6, 9, 12 months
|
Validated tool assessing female sexual function in women with pelvic floor disorders; higher scores reflect better sexual functioning
|
Baseline to 3, 6, 9, 12 months
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Patient global impression of improvement (PGI-I)
Time Frame: 3, 6, 9, 12 months
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Global measure of patient impression of improvement, likert scale
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3, 6, 9, 12 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
PROMIS Cognitive Function-Short Form
Time Frame: Baseline to 3, 6, 9, 12 months
|
Generic cognitive function measure (8 items), higher scores indicate better function
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Baseline to 3, 6, 9, 12 months
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Vivian Sung, MD, MPH, Women and Infants Hospital of Rhode Island
- Principal Investigator: Peter Jeppson, MD, University of New Mexico
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Behavioral Symptoms
- Mental Disorders
- Urologic Diseases
- Lower Urinary Tract Symptoms
- Urological Manifestations
- Urination Disorders
- Elimination Disorders
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Urinary Incontinence
- Enuresis
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Peripheral Nervous System Agents
- Cholinergic Agents
- Urological Agents
- Membrane Transport Modulators
- Acetylcholine Release Inhibitors
- Neuromuscular Agents
- Adrenergic beta-Agonists
- Botulinum Toxins, Type A
- abobotulinumtoxinA
- Adrenergic Agonists
- Mirabegron
- Adrenergic Agents
- Adrenergic beta-3 Receptor Agonists
Other Study ID Numbers
- 1895985
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ANALYTIC_CODE
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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