Tolterodine treatment for children with symptoms of urinary urge incontinence suggestive of detrusor overactivity: results from 2 randomized, placebo controlled trials.
OBJECTIVE
We report the results of the first 2 large randomized controlled trials designed to evaluate the efficacy and safety of tolterodine extended release in children 5 to 10 years old with symptoms of urinary urge incontinence suggestive of detrusor overactivity.


METHODS
Two double-blind, placebo controlled trials were conducted sequentially. Children 5 to 10 years old with incontinence suggestive of detrusor overactivity (1 or more diurnal incontinence episodes per 24 hours) were randomized to tolterodine (2 mg daily) or placebo for 12 weeks. The primary end point was the change from baseline to week 12 in the number of incontinence episodes per week. Changes from baseline in the number of voids per 24 hours and volume of urine per void were also evaluated. Exploratory analyses were conducted to determine whether particular subsets of patients showed differential responses to treatment.


RESULTS
A total of 224 and 487 children (mean age 8 years) were randomized to placebo and tolterodine, respectively. Differences in the number of incontinence episodes per week, voids per 24 hours, and volume of urine per void between tolterodine and placebo did not reach statistical significance. This finding may be explained by a high placebo response and under dosage of tolterodine among children with greater body weight. Tolterodine was well tolerated.


CONCLUSIONS
Analysis of the primary efficacy outcome did not reveal a statistically significant effect of treatment. However, secondary analyses demonstrated that tolterodine was well tolerated among 5 to 10-year-old children with diurnal incontinence. Exploratory analyses also showed that children weighing 35 kg or less with detrusor overactivity characterized by incontinence and/or frequent voiding benefited most from tolterodine treatment, suggesting that a weight adjusted dosing regimen may be required for optimal response among older and heavier children.
Nijman
Rien J M
RJ
Department of Urology, Groningen University Hospital, Groningen, The Netherlands. j.m.nijman@chir.azg.nl
Borgstein
Niels G
NG
Ellsworth
Pamela
P
Djurhuus
Jens C
JC
D001559:Benzhydryl Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003408:Cresols / Q000008:administration & dosage / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010665:Phenylpropanolamine / Q000008:administration & dosage / Q000627:therapeutic use*; D015990:Placebo Effect; D010919:Placebos; D012449:Safety; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000652:urine; D014554:Urination / Q000187:drug effects
D001559:Benzhydryl Compounds; D003408:Cresols; D003692:Delayed-Action Preparations; D018727:Muscarinic Antagonists; D010919:Placebos; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate