title: Randomized controlled trial of cyclic and continuous therapy with trospium and solifenacin combination for severe overactive bladder in elderly patients with regard to patient compliance.
abstract: OBJECTIVE
  The aim of the study was to increase the efficiency of treatment for severe symptoms of overactive bladder (OAB) with antimuscarinic drugs in elderly men and women.
  
  
  METHODS
  A total of 341 patients over 65 years of age (average age 69.9; 186 women and 155 men) with severe symptoms of OAB (frequency of incontinence episodes [IEs] ≥ 3/day) underwent examination. Patients were distributed into three main groups: A (n = 58; trospium 60 mg/day + solifenacin 20): three cycles, each cycle 8 weeks, with an 8-week interval; B (n = 55; trospium 30 mg/day + solifenacin 10), regimen was the same as in group A; C (n = 62; trospium 30 mg/day + solifenacin 10) daily during 1 year.
  
  
  RESULTS
  The most successful treatment for the clinical and urodynamic symptoms of OAB was observed in group A, without an increase in the quantity or intensity of side effects (IEs = 4.8 (0.9) → 1.4 (0.8); p ≤ 0.01). Groups B and C also demonstrated positive effects for most of the markers for lower urinary tract state with statistical significance p ≤ 0.01. Nonparametric correlation between decrease in IEs and relative number of patients who accurately fulfilled prescriptions was in group A, r = 0.53, p ≤ 0.05; in group B, r = 0.61; p ≤ 0.05; in group C, r = 0.55, p ≤ 0.05.
  
  
  CONCLUSIONS
  Cyclic therapy with two different spectrum antimuscarinics appears to be effective for controlling severe OAB in elderly patients. One-year cyclic therapy with a trospium and solifenacin combination provides a high compliance level (76-84%). However, continuous therapy with standard doses of trospium and solifenacin results in low adherence and high rates of treatment withdrawals (≥ 66%) despite satisfactory clinical and urodynamic results.
authors.affiliation: Department of Adaptive Medicine, Humanities Institute of Social Sciences, Far Eastern Federal University, Ayax 10, corp. F-733, Vladivostok, Russian Federation.
authors.forename: Kirill V
authors.initials: KV
authors.lastname: Kosilov
authors.affiliation: Department of Urology, City Polyclinic No. 3, Vladivostok, Russian Federation.
authors.forename: Sergay A
authors.initials: SA
authors.lastname: Loparev
authors.affiliation: Far Eastern Fisheries University, Vladivostok, Russian Federation.
authors.forename: Marina A
authors.initials: MA
authors.lastname: Ivanovskaya
authors.affiliation: Department of the Functional Methods of Examination, Medical Association No. 2 of Vladivostok-sity, Vladivostok, Russian Federation.
authors.forename: Liliya V
authors.initials: LV
authors.lastname: Kosilova
keywords: elderly; overactive bladder; solifenacin; trospium