title: How are women with SUI-symptoms treated with duloxetine in real life practice? - preliminary results from a large observational study in Germany.
abstract: BACKGROUND
  Duloxetine was found safe and effective in the treatment of moderate to severe female stress urinary incontinence (SUI) in controlled clinical trials; complementary data from routine clinical practice are still wanted.
  
  
  OBJECTIVE
  To explore the use of various initial duloxetine doses by physicians in the treatment of female SUI in routine clinical practice and its implications on drug safety and patients' subjective impression of effectiveness.
  
  
  METHODS
  Adult women treated with duloxetine for SUI symptoms were documented as part of an ongoing large-scale observational study in Germany. Data collected at baseline, after 4 and 12 weeks, were evaluated by initial doses. Statistics were descriptive, 95% confidence intervals were calculated for adverse event (AE) rates.
  
  
  RESULTS
  A total of 7888 adult women were treated with duloxetine; their mean age was 61.4 years, body mass index 27 kg/m(2), incontinence episode frequency (IEF) 14.0 per week. Previous SUI treatments were observed in 52.2%, comorbidities in 60.4% of the patients. A total of 90.7% reported reduced frequency of SUI-episodes, 12.1% any AE; nausea (5.7%) and vertigo (1.6%) were reported most frequently. In all, 52.2% of patients were initiated on a duloxetine dose of 40 mg/day. Only minor differences in patient characteristics, effectiveness and tolerability were associated with varying initial duloxetine doses.
  
  
  CONCLUSIONS
  Many women received lower duloxetine doses than expected based on evidence-based dosing recommendations. Although SUI patients in this study had a higher health risk because of old age and multiple comorbidities than in previous controlled clinical trials, AE rates were lower, possibly because of the observational character of the study and/or the use of rather low doses. Similar AE rates for varying initial doses possibly reflect sensible dose-adjustment to individual needs.
authors.affiliation: Medical Department, Lilly Deutschland GmbH, Bad Homburg, Germany. manningm@lilly.com
authors.forename: M
authors.initials: M
authors.lastname: Manning
authors.forename: U
authors.initials: U
authors.lastname: Gotsch
authors.forename: A
authors.initials: A
authors.lastname: Minarzyk
authors.forename: D
authors.initials: D
authors.lastname: Quail
authors.forename: A
authors.initials: A
authors.lastname: Gross
authors.forename: I
authors.initials: I
authors.lastname: Pages
authors.forename: H D
authors.initials: HD
authors.lastname: Methfessel
authors.forename: M C
authors.initials: MC
authors.lastname: Michel
mesh_terms: D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D000068736:Duloxetine Hydrochloride; D005260:Female; D005858:Germany; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D013876:Thiophenes / Q000008:administration & dosage* / Q000009:adverse effects; D014550:Urinary Incontinence, Stress / Q000188:drug therapy*
chemical_list: D000068736:Duloxetine Hydrochloride; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes