Reduced perception of urgency in treatment of overactive bladder with extended-release tolterodine.
OBJECTIVE
To evaluate the effect of once-daily, extended-release tolterodine on urinary urgency in patients with overactive bladder.


METHODS
Patients with urinary frequency (eight or more micturitions per 24 hours) and urge incontinence (five or more episodes per week) were randomized to oral treatment with tolterodine extended release 4 mg once daily (n=398) or placebo (n=374) for 12 weeks. Efficacy was assessed by use of patient perception evaluations.


RESULTS
The results presented are a secondary analysis of this double-blind, placebo-controlled study. Of patients treated with tolterodine extended release, 44% reported improved urgency symptoms (compared with 32% for placebo), and 62% reported improved bladder symptoms (placebo, 48%) (both P<.001 compared with placebo). The odds of reducing urgency and improving bladder symptoms were 1.68 and 1.78 times greater, respectively, for patients in the tolterodine extended release group than for patients receiving placebo. In response to urgency, there was a more than six-fold increase in the proportion of patients able to finish a task before voiding in the tolterodine extended release group. The proportion of patients unable to hold urine upon experiencing urgency was also decreased by 58% with tolterodine, compared with 32% with placebo (P<.001). The proportion of patients reporting "much benefit" from treatment was greater for tolterodine extended release than for placebo (43% versus 24%; P<.001). The only adverse events with an incidence of greater than 5% were dry mouth, headache, and constipation, with only dry mouth markedly more frequent with tolterodine than with placebo.


CONCLUSIONS
Tolterodine extended release has demonstrable efficacy in reducing the severity of urinary urgency and is associated with improvements in overactive bladder symptoms that are meaningful to patients.
Freeman
Robert
R
Urogynaecology Unit, Derriford Hospital, Plymouth, United Kingdom. robert.freeman@phnt.swest.nhs.uk
Hill
Simon
S
Millard
Richard
R
Slack
Mark
M
Sutherst
John
J
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D016001:Confidence Intervals; D003408:Cresols / Q000627:therapeutic use*; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists; D016017:Odds Ratio; D017060:Patient Satisfaction; D010665:Phenylpropanolamine; D011336:Probability; D012016:Reference Values; D012720:Severity of Illness Index; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000188:drug therapy; D014549:Urinary Incontinence / Q000175:diagnosis / Q000188:drug therapy*; D014555:Urination Disorders / Q000175:diagnosis / Q000188:drug therapy*
D001559:Benzhydryl Compounds; D003408:Cresols; D003692:Delayed-Action Preparations; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate