In a recent study, fesoterodine showed rapid onset of efficacy at one week in patients with overactive bladder (OAB) who were previously treated with tolterodine and dissatisfied with that drug.
The open-label, 12-week study included 516 adult OAB patients (mean age 60 years) who reported urinary frequency and urgency in five-day bladder diaries at baseline and dissatisfaction with previous tolterodine or tolterodine extended-release treatment received within two years of screening. The study population included 398 women (77%) and 118 men (23%).
All patients received 4 mg fesoterodine once daily during the first four weeks of treatment. The researchers, led by Howard B. Goldman, MD, of the Glickman Urologic and Kidney Institute at Cleveland Clinic in Ohio, defined urinary frequency as eight or more micturitions per 24 hours and urgency as three or more episodes per 24 hours. The investigators defined urgency and severe urgency episodes as those rate 3 or more and 4 or more, respectively, on the five-point Urinary Sensation Scale (USS).
The diary-dry rate at week 1 (the fraction of subjects reporting at least one urge urinary incontinence [UUI] episode at baseline who subsequently reported no UUI episodes in the week 1 diary) was 38%, according to an online report in BJU International. From baseline to week 1, the total number of micturitions, UUI episodes (for subjects reporting UUI at baseline), nocturnal micturitions, urgency episodes, and severe urgency episodes (for subjects reporting severe urgency at baseline) decreased by a median of 9.5%, 75%, 13%, 22.1%, and 50%, respectively.
The authors concluded that fesoterodine 4 mg was associated with significant improvements in all bladder diary variables assessed. These findings are consistent with previous early-onset studies of other antimuscarinics, they noted.
“The rapid improvement in OAB symptoms associated with fesoterodine is important because these symptoms are often troublesome and can negatively impact HRQL [health-related quality of life],” Dr. Goldman’s group wrote.
Although prescribing guidelines for fesoterodine state that the dose can be titrated upwards when clinically appropriate, “this study may give further information to determine when that should be done.” Dr. Goldman told Renal & Urology News.