Characteristics of antimuscarinic responders versus suboptimal responders in a randomized clinical trial of patients with overactive bladder symptoms

To assess the characteristics of tolterodine extended-release (ER) 4 mg responders and suboptimal responders (≤50% decrease in UUI episodes/24 h) among patients with overactive bladder (OAB), including urgency urinary incontinence (UUI), and identify predictors of a >50% UUI response with fesoterodine 8 mg in tolterodine suboptimal responders.

Adult patients with OAB symptoms for ≥6 months and ≥8 micturitions, and ≥2 and <15 UUI episodes/24 h at week -2 received open-label tolterodine ER 4 mg during a 2-week run-in. Suboptimal responders after tolterodine treatment (week 0) were randomized to fesoterodine (4 mg for 1 week, 8 mg for weeks 2-12) or placebo once daily. Post-hoc analyses compared the percent change from week -2 to week 0 in UUI episodes/24 h in tolterodine responders versus suboptimal responders and identified significant predictors of a UUI response at week 12 with fesoterodine 8 mg among tolterodine suboptimal responders.

Of 897 patients, 610 (68%) were UUI suboptimal responders during the run-in period. UUI episodes/24 h at week -2 were similar in tolterodine responders and suboptimal responders (4.2 vs 4.3), but responders showed a significantly greater median percent decrease in UUI episodes/24 h after tolterodine treatment at week 0 (80.0% versus 15.3%; P<0.0001). During double-blind treatment, the percentage of patients with a UUI response at week 12 was significantly greater with fesoterodine (69.9%) than placebo (57.0%; P = 0.0027). Fesoterodine (vs placebo), no previous antimuscarinic use before tolterodine run-in, and less UUI severity at baseline were significant predictors of a UUI response.

For patients with OAB, including UUI, who were treated initially with tolterodine and showed a suboptimal UUI response, nearly 70% demonstrated a UUI response with second-line fesoterodine 8 mg. No antimuscarinic use before tolterodine and fewer baseline UUI episodes were significant predictors of a UUI response with fesoterodine.

Current medical research and opinion. 2017 Jul 31 [Epub ahead of print]

Lars Grenabo, Sender Herschorn, Steven A Kaplan, Linda Cardozo, David Scholfield, Daniel Arumi, Martin Carlsson, Douglass Chapman, Fady Ntanios

a Department of Urology , University of Gothenburg , Gothenburg , Sweden., b Department of Urology , University of Toronto , Toronto , Canada., c Icahn School of Medicine at Mount Sinai , New York , NY , USA., d Department of Urogynaecology , King's College Hospital , London , United Kingdom., e Pfizer Ltd , Sandwich , United Kingdom., f Pfizer Europe , Madrid , Spain., g Pfizer Inc , New York , NY , USA.