Do patient characteristics predict which patients with overactive bladder benefit from a higher fesoterodine dose?

We sought to determine whether baseline characteristics predict which overactive bladder (OAB) patients benefit from fesoterodine 8 mg versus 4 mg.

In double-blind, placebo-controlled, flexible-dose trials, baseline characteristics of OAB patients with ≥ 1 urgency urinary incontinence (UUI) episodes/24 h who escalated from fesoterodine 4 mg to 8 mg were evaluated. Possible dose-escalation predictors (age; sex; previous antimuscarinic use; UUI, micturitions, and urgency episodes/24 h; race; body mass index; time to dose escalation; OAB duration) were compared in escalators versus non-escalators. Patients from fixed-dose trials with dose-escalator characteristics were identified (matched dose-escalator sample) to assess changes from baseline with fesoterodine 4 mg, 8 mg, and placebo.

In flexible-dose trials, significant predictors of fesoterodine dose escalation were younger age (≤ 65.8 years), greater number of baseline micturitions (≥ 13.1) and urgency episodes/24 h (≥ 10.9), greater OAB duration (≥ 9.1 years), and more frequent previous antimuscarinic use (58.3%), but not baseline UUI episodes/24 h. In the matched dose-escalator sample (fesoterodine 4 mg: n = 215; 8 mg: n = 198; placebo: n = 217), change from baseline in UUI episodes significantly improved with fesoterodine 8 mg versus 4 mg (P = 0.043) and with both doses versus placebo (P < 0.001). Dry mouth and constipation rates were higher with fesoterodine 8 mg.

Dose-escalator patients had a significantly greater UUI response with fesoterodine 8 mg versus 4 mg. Given the potential for adverse events, fesoterodine 4 mg is recommended to start; however, patients with UUI and identified predictors may benefit from initial treatment with fesoterodine 8 mg or rapid dose escalation.

International urogynecology journal. 2018 Mar 29 [Epub ahead of print]

Howard B Goldman, Matthias Oelke, Steven A Kaplan, Tekeya Kitta, David Russell, Martin Carlsson, Daniel Arumi, Erin Mangan, Fady Ntanios

Cleveland Clinic Main Campus, Mail Code Q10-1; 9500 Euclid Avenue, Cleveland, OH, 44195, USA. ., St. Antonius Hospital, Gronau, Germany., Weill Cornell Medical College, New York, NY, USA., Hokkaido University, Sapporo, Japan., Pfizer Inc, New York, NY, USA., Pfizer Europe, Madrid, Spain.