Fesoterodine : individualised treatment of urgency urinary incontinence across patient groups
Faculty of Medicine and Health Sciences
European urology: supplements / European Association of Urology. - Basel
, p. 14-22
University of Antwerp
Context Effective symptom reduction has the potential to significantly improve health-related quality of life (HRQoL) in patients with overactive bladder (OAB), particularly those experiencing urgency urinary incontinence (UUI). Objective To assess the evidence for flexible therapy with fesoterodine for patients with OAB, focussing on UUI. Evidence acquisition A nonsystematic search performed in 2010 was used to identify relevant literature regarding fesoterodine therapy. Evidence synthesis Antimuscarinic medications are the first-line pharmacotherapy for OAB, and tolterodine has been the treatment of choice for many patients. However, optimal efficacy may be difficult to achieve because of tolterodine's limited dosing options. Fesoterodine, a nonselective oral antimuscarinic with the same active metabolite as tolterodine, provides an alternative option. After oral administration, fesoterodine is rapidly and extensively converted into 5-hydroxymethyl tolterodine by ubiquitous, nonspecific plasma esterases, thus bypassing the hepatic cytochrome P450 pathway that mediates the metabolism of tolterodine. The superiority of fesoterodine 8 mg over tolterodine extended release (ER) 4 mg for the effective relief of UUI episodes and other OAB symptoms and improvements in HRQoL has been demonstrated in two superiority-design, head-to-head, randomised, placebo-controlled, clinical trials in patients with OAB and UUI. The majority of patients achieved dryness with fesoterodine 8 mg, a significantly higher percentage than with tolterodine ER 4 mg. Clear dose-response relationships have been defined for fesoterodine in OAB patients for many outcomes, including UUI episodes, mean voided volume, continent days per week and self-reported treatment response. The dose-response magnitude for improving UUI episodes was larger in patients with greater UUI severity. Flexible dosing with fesoterodine appears to be well tolerated, with no unexpected safety signals during long-term treatment and high rates of patient-reported treatment satisfaction. Conclusions Flexible dosing with fesoterodine 4 mg and 8 mg allows for maximisation of treatment efficacy for a broad spectrum of patients with OAB. Take Home Message Fesoterodine 8 mg demonstrated superiority over tolterodine extended release 4 mg in improving episodes of urgency urinary incontinence in two head-to-head, randomised, placebo-controlled trials in patients with overactive bladder (OAB). Flexible dosing with fesoterodine allows individualised treatment for a broad spectrum of patients with OAB.