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Overactive BladderPhase 4NCT01824420

Flexibly adding-on Second Antimuscarinic Agent to the First Antimuscarinics for Refractory Overactive Bladder Syndrome

A Phase 4 study testing Detrusitol 4mg QD and Oxybutynin ER 5mg QD and Detrusitol 4mg QD in people with Overactive Bladder, run by Buddhist Tzu Chi General Hospital at 1 site in Taiwan.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

To investigate if oxybutynin ER adding on antimuscarinics is more effective than mono-antimuscarinic treatment for patients with refractory OAB Read more about this study

Who is it for?
Ages 20 to 65 years
Conditions the study is for
Overactive Bladder
What is being tested?
Detrusitol 4mg QD and Oxybutynin ER 5mg QD and Detrusitol 4mg QD
Could I receive a placebo?
No, everyone receives an active treatment
How many people
129 participants
Where
1 siteTaiwan
Study dates
Mar 2013to Feb 2017
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients aged ≥20 years of male or female gender with OAB refractory to one antimuscarinics therapy
  • Patient or his/her legally acceptable representative has signed the written informed consent form

Who cannot join

  • Patients with untreated bladder outlet obstruction, intrinsic sphincter deficiency, pelvic organ prolapse
  • Patients with history of urethral injury or transurethral surgery for prostate or bladder
  • Patients with severe cardiopulmonary disease and such as congestive heart failure, arrhythmia, poorly controlled hypertension, not able to receive regular follow-up
  • Patients with known active urinary tract infection, urinary stone or malignancy
  • Patients have laboratory abnormalities at screening including:
  • Aspartate aminotransferase (AST) > 3 x upper limit of normal range.
Show all 12Show fewer
  • Alanine aminotransferase (ALT) > 3 x upper limit of normal range.
  • Patients have abnormal serum creatinine level > 2 x upper limit of normal range.
  • Patients with urinary retention, PVR≥250 ml
  • Patients with any other serious disease or condition considered by the investigator not suitable for entry into the trial
  • Patients participated investigational drug trial within 1 month before entering this study
  • Patients with major psychiatric illness or drug abuse

Trial locations and contacts

1 site in 1 country.

Taiwan1 site
  • Buddhist Tzu Chi General Hospital

    Hualien City, 970

Other trials in Taiwan

About this study

Official title: Flexibly adding-on Second Antimuscarinic Agent to the First Antimuscarinics for Refractory Overactive Bladder Syndrome - A Prospective Randomized Controlled Comparative Study With Mono-antimuscarinic Therapy

To investigate if oxybutynin ER adding on antimuscarinics is more effective than mono-antimuscarinic treatment for patients with refractory OAB

Read the detailed description
  • Introduction:Overactive bladder (OAB) is a symptom syndrome characterized by urgency frequency with or without urgency incontinence. Usually no metabolic or anatomical disorders can be found in patients with OAB, and the condition may have a great impact on quality of life. Antimuscarinics are the first line treatment and yield a success rate of more than 70%. Urothelial dysfunction and abnormalities of sensory receptor expression or transmitter release in the suburothelial nerves might contribute to OAB which is refractory to antimuscarinics. In patients who failed current antimuscarinic treatment, intravesical botulinum toxin A (BoNT-A) injection provides an chance of improvement. Previous studies reported success rates of BoNT-A injection for OAB ranged from 60 to 80%. Intravesical treatment to inhibit abnormal receptor expression or transmitter release in the sensory nerve terminals of the suburothelial space can provide good therapeutic effects in the treatment of OAB. However, patients might develop large postvoid residual (PVR) and subsequent urinary tract infection (UTI) after BoNT-A injections, therefore, this treatment is usually left for patients who are refractory to antimuscarinic therapy. However, how to define antimuscarinic refractory OAB remains controversial. How many different types of antimuscarinics should be prescribed before we call the case failure has not been elucidated. The aim of this study is to evaluate the effect of flexibly adding-on oxybutynin ER (5mg QD) in patients with OAB who were refractory to monotherapy with the first antimuscarinic agent (tolterodine 4mg QD).
  • Methods: A total of 200 patients with refractory OAB will be included in this prospective, open label protocol. Inclusion criteria are persistent OAB symptoms (frequency urgency with/without urgency urinary incontinence) after behaviour therapy and an optimized dose of one antimuscarinic agent (Tolterodine 4mg) for at least 3 months. Patients with neurogenic diseases, untreated bladder outlet obstruction, recurrent UTI, large PVR (>150ml) will be excluded from this study. Patients will be randomized to allocate in the treatment group (receiving tolterodine 4mg QD and oxybutynin 5mg to 15mg QD) or control group (tolterodine 4mg QD) in 1:1 ratio based on the permuted block randomization code. Oxybutynin ER 5mg to 15 mg once daily will be flexibly adding-on from baseline to the third month in the treatment group, depending on patient's effectiveness and tolerability to adverse events. At the baseline, 1 and 3 months after oxybutynin ER adding-on, we will assess the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), the Urgency Severity Scale (USS) questionnaires, uroflowmetry and PVR. The therapeutic effect will be considered as successful if there was a reduction of PPBC of 2 from baseline and a reduction of USS of 1 from baseline, or the USS value is 0 at 3 months. The adverse events and tolerability of this combined therapy will also be assessed.
  • Expected Results: Compared with baseline, total IPSS, IPSS storage subscore, quality of life indexes, OABSS, USS and PPBC will be expected to significantly decrease at 1 and 3 months. PVR might be increased at 3 months after adding-on treatment. The changes of IPSS voiding subscore, peak urinary flow rate and voided volume might be increased or comparable to the control group during the follow-up. We expect at least one-third of patients can have a successful therapeutic effect without significantly increased adverse events. However, the other patients might withdraw from the study due to adverse events such as severe dry mouth, constipation, large PVR, UTI, severe difficult urination or acute urinary retention.

Adverse events should be cautiously monitored during the treatment course.

Being tested
Detrusitol 4mg QD and Oxybutynin ER 5mg QD, Detrusitol 4mg QD
Keywords
Refractory overactive bladder syndrome, Antimuscarinic agent
Medical subject headings
Urinary Bladder, Overactive

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Detrusitol 4mg QD and Oxybutynin ER 5mg QDDrug

    Also called Tolterodine (Detrusitol) 4mg QD, Oxybutynin (Ditropan) ER 5mg QD

    Study group

  • Detrusitol 4mg QDDrug

    Also called Tolterodine (Detrusitol) 4mg QD

    Control group

Study groups in NCT01824420
Study groupRoleWhat they receive
Study groupExperimentalTolterodine (Detrusitol) 4mg QD and Oxybutynin (Ditropan) ER 5mg QD
Receives: Drug: Detrusitol 4mg QD and Oxybutynin ER 5mg QD
Control groupExperimentalTolterodine (Detrusitol) 4mg QD
Receives: Drug: Detrusitol 4mg QD

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change from Baseline in the Perception of Bladder Condition (PPBC) at different time points

    Efficacy:

    Change from Baseline in the Perception of Bladder Condition (PPBC) at different time points (1 month, 2 months and 3 months). If patients have a PPBC improved by two scales, they are considered as successfully treated, otherwise failed treatment.

    Safety:

    Systemic adverse events such as difficult urination, dry mouth, dry eye, blurred vision, constipation, dizziness or general weakness

    Measured: 1 month, 2 months and 3 months

Secondary outcomes (8)
  1. Change from Baseline in the Overactive Bladder Symptom Score (OABSS) at different time points

    Efficacy:

    Change from Baseline in the Overactive Bladder Symptom Score (OABSS) at different time points (1 month, 2 months and 3 months).

    Safety:

    Systemic adverse events such as difficult urination, dry mouth, dry eye, blurred vision, constipation, dizziness or general weakness

    Measured: 1 month, 2 months and 3 months

  2. Change from Baseline in the urinary sensation scale (USS) at different time points

    Efficacy:

    Change from Baseline in the urinary sensation scale (USS) at different time points (1 month, 2 months and 3 months).

    Safety:

    Systemic adverse events such as difficult urination, dry mouth, dry eye, blurred vision, constipation, dizziness or general weakness

    Measured: 1 month, 2 months and 3 months

  3. Change from Baseline in the International Prostate Symptom Score (IPSS) at different time points

    Efficacy:

    Change from Baseline in the International Prostate Symptom Score (IPSS) at different time points (1 month, 2 months and 3 months).

    Safety:

    Systemic adverse events such as difficult urination, dry mouth, dry eye, blurred vision, constipation, dizziness or general weakness

    Measured: 1 month, 2 months and 3 months

  4. Change from Baseline in the maximum flow rate (Qmax) at different time points

    Efficacy:

    Change from Baseline in the maximum flow rate (Qmax) at different time points (1 month, 2 months and 3 months).

    Safety:

    Systemic adverse events such as difficult urination, dry mouth, dry eye, blurred vision, constipation, dizziness or general weakness

    Measured: 1 month, 2 months and 3 months

  5. Change from Baseline in the voided volume at different time points

    Efficacy:

    Change from Baseline in the voided volume at different time points (1 month, 2 months and 3 months).

    Safety:

    Systemic adverse events such as difficult urination, dry mouth, dry eye, blurred vision, constipation, dizziness or general weakness

    Measured: 1 month, 2 months and 3 months

  6. Change from Baseline in the postvoid residual volume (PVR) at different time points

    Efficacy:

    Change from Baseline in the postvoid residual volume (PVR) at different time points (1 month, 2 months and 3 months).

    Safety:

    Systemic adverse events such as difficult urination, dry mouth, dry eye, blurred vision, constipation, dizziness or general weakness

    Measured: 1 month, 2 months and 3 months

  7. Change from Baseline in the total prostate volume (TPV) at different time points

    Efficacy:

    Change from Baseline in the total prostate volume (TPV) at different time points (1 month, 2 months and 3 months) are evaluated in men

    Safety:

    Systemic adverse events such as difficult urination, dry mouth, dry eye, blurred vision, constipation, dizziness or general weakness

    Measured: 1 month, 2 months and 3 months

  8. Change from Baseline in the transition zone index (TZI) at different time points

    Efficacy:

    Change from Baseline in the transition zone index (TZI) at different time points (1 month, 2 months and 3 months) are evaluated in men

    Safety:

    Systemic adverse events such as difficult urination, dry mouth, dry eye, blurred vision, constipation, dizziness or general weakness

    Measured: 1 month, 2 months and 3 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Apr 2013 (estimated)
  2. Study startMar 2013
  3. Primary completionFeb 2017
  4. Study completionFeb 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Prospective, open-label study. The overactive bladder patients maintained their previous antimuscarinic medication and we flexibly added on the second antimuscarinic drug (oxybutynin ER 5 mg QD) or not.
Masking
None (open label)
Enrolment
129 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01824420
Sponsor's protocol ID
TCGHUROL008
Status last verified
Mar 2017
First submitted
1 Apr 2013
Last updated
8 Mar 2017
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No: IPD cannot be released unless approval by the Ethics Committee of the Buddhist Tzu Chi General Hospital, Hualien, Taiwan

Publications

  • Abrams P, Kelleher CJ, Kerr LA, Rogers RG. Overactive bladder significantly affects quality of life. Am J Manag Care. 2000 Jul;6(11 Suppl):S580-90.

    PubMed 11183901
  • Chapple CR. Muscarinic receptor antagonists in the treatment of overactive bladder. Urology. 2000 May;55(5A Suppl):33-46; discussion 50. doi: 10.1016/s0090-4295(99)00492-6.

    PubMed 10767450
  • Yiangou Y, Facer P, Ford A, Brady C, Wiseman O, Fowler CJ, Anand P. Capsaicin receptor VR1 and ATP-gated ion channel P2X3 in human urinary bladder. BJU Int. 2001 Jun;87(9):774-9. doi: 10.1046/j.1464-410x.2001.02190.x.

    PubMed 11412212
  • Apostolidis A, Popat R, Yiangou Y, Cockayne D, Ford AP, Davis JB, Dasgupta P, Fowler CJ, Anand P. Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol. 2005 Sep;174(3):977-82; discussion 982-3. doi: 10.1097/01.ju.0000169481.42259.54.

    PubMed 16094018
  • Simpson LL. Kinetic studies on the interaction between botulinum toxin type A and the cholinergic neuromuscular junction. J Pharmacol Exp Ther. 1980 Jan;212(1):16-21.

    PubMed 6243359
  • Kuo HC. Urodynamic evidence of effectiveness of botulinum A toxin injection in treatment of detrusor overactivity refractory to anticholinergic agents. Urology. 2004 May;63(5):868-72. doi: 10.1016/j.urology.2003.12.007.

    PubMed 15134967
  • Kuo HC. Comparison of effectiveness of detrusor, suburothelial and bladder base injections of botulinum toxin a for idiopathic detrusor overactivity. J Urol. 2007 Oct;178(4 Pt 1):1359-63. doi: 10.1016/j.juro.2007.05.136. Epub 2007 Aug 16.

    PubMed 17706718

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Detrusitol 4mg QD and Oxybutynin ER 5mg QD and Detrusitol 4mg QD in people with Overactive Bladder, run by Buddhist Tzu Chi General Hospital at 1 site in Taiwan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 Mar 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Taiwan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change from Baseline in the Perception of Bladder Condition (PPBC) at different time points (time frame: 1 month, 2 months and 3 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01824420, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Mar 2017.

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