Efficacy and Tolerability of Fesoterodine in Older and Younger Subjects With Overactive Bladder

Kraus, Stephen R.; Ruiz-Cerdá, J.L.; Martire, Diane L.; Wang, Joseph T.; Wagg, Adrian

doi:10.1016/j.urology.2010.03.097

Cited by 57 publications

(69 citation statements)

References 26 publications

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“…These results in this subgroup support those of the post hoc analysis of data from two randomized, fixeddose, placebo-controlled studies that indicated that the 4-and 8-mg doses of fesoterodine effectively treated OAB symptoms in individuals younger than 75, with the 8-mg dose being most effective in those aged 75 and older. 22 These findings, together with the high rate of dose escalation with fesoterodine in the present study and in previous flexible-dose fesoterodine studies, 20 suggest that some elderly adults require higher doses of medication to achieve effective relief of OAB symptoms, contrary to commonly held beliefs about drug treatment in elderly adults. 38 One potential limitation of this study is that the mean MMSE score of the participants at baseline was approximately 28 in both treatment groups, suggesting that the participants were functioning at a high level even though the inclusion criteria required a score of only 20.…”

Section: Discussionsupporting

confidence: 58%

Flexible‐Dose Fesoterodine in Elderly Adults with Overactive Bladder: Results of the Randomized, Double‐Blind, Placebo‐Controlled Study of Fesoterodine in an Aging Population Trial

Wagg

Khullar

Marschall-Kehrel³

et al. 2013

J American Geriatrics Society

117

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Section: Discussionsupporting

confidence: 58%

Flexible‐Dose Fesoterodine in Elderly Adults with Overactive Bladder: Results of the Randomized, Double‐Blind, Placebo‐Controlled Study of Fesoterodine in an Aging Population Trial

Wagg

Khullar

Marschall-Kehrel³

et al. 2013

J American Geriatrics Society

117

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“…5-HMT appears to be less permeable across the BBB and may be a substrate for active transport by the P-glycoprotein transporter [15]. The drug does not require hepatic metabolism to become active and, compared to other drugs in this class, has less potential for pharmacokinetic variability in individuals with liver dysfunction [43,44]. While in theory fesoterodine should have a low risk for adverse CNS effects, it has not been formally evaluated in a clinical trial to determine the rate of cognitive impairment in elderly patients with OAB.…”

Section: Fesoterodinementioning

confidence: 99%

Antimuscarinic Drugs: Review of the Cognitive Impact When Used to Treat Overactive Bladder in Elderly Patients

2011

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The blockade of muscarinic receptors in the management of overactive bladder (OAB) symptoms provides beneficial as well as adverse effects. The cognitive changes observed are caused by the drugs' ability to cross the blood-brain barrier and bind to muscarinic receptors within the central nervous system (CNS). To date, while not specifically testing for CNS side effects, most of the controlled efficacy trials of multiple OAB medications have not shown significant adverse effects on cognitive function. However, elderly individuals, in whom OAB is more prevalent, often are excluded from these studies. The few trials that have performed cognitive testing in healthy elderly people taking antimuscarinics have clearly shown that oxybutynin can adversely affect cognition. Darifenacin, trospium, solifenacin, and tolterodine appear to have little to no risk of causing CNS side effects in this population. However, caution needs to be used in elderly patients with preexisting dementia.

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“…13 Notably, studies with both fesoterodine and solifenacin have demonstrated that a large proportion of elderly patients require higher doses for optimal efficacy. 8,9 Older people do complain of more adverse events from therapy but, as previously noted, older patients appear to be more adherent to their therapies than younger patients (Figure 2). 10 …”

Section: Antimuscarinics: Efficacymentioning

confidence: 62%

“…In direct contradiction to the usual geriatric paradigms of prescribing, older people: are more likely than young to require, and ask for, medication for their bladder problem; 7 appear to require higher doses of medication; 8,9 and, despite higher reported rates of adverse events, are more adherent to their medication than younger users. 10 …”

Section: Treatment Of Oab In Older Patientsmentioning

confidence: 92%

Treating overactive bladder in the elderly

Wagg

2011

CUAJ

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The prevalence of the overactive bladder (OAB) symptom complex increases with age. Older people also appear to experience more severe incontinence syndromes, including OAB, than their younger counterparts. Older patients are more likely than younger individuals to ask for medication for bladder problems and to require higher doses of medication. Conventional treatment for OAB with conservative and lifestyle measures in combination with antimuscarinic pharmacotherapy is effective in older people. Although there is a theoretical potential for cognitive impairment with antimuscarinic agents, the newer antimuscarinics are cognitively safe in cognitively intact older people.T he overactive bladder (OAB) symptom complex, much like all lower urinary tract symptoms, is increasingly prevalent in association with increasing age.1,2 This brief review outlines the epidemiology of these symptoms in later life and discusses the particular changes that occur in the aging lower urinary tract. In addition, the use of antimuscarinic agents in older patients is reviewed, including a discussion of the potential for the antimuscarinic effects to have a detrimental impact on cognitive function. Changes in the urinary tract associated with agingNatural changes in the urinary tract may account for some of the apparent increase in lower urinary tract symptoms with increasing age. The sensation of bladder filling is reduced and bladder capacity falls, leading to an older person having less time to respond to the call to urinate and perhaps explaining why many older people complain of severe urge, rather than urgency, as defined by the International Continence Society.3 However, older people also experience a more severe degree of incontinence, including OAB, than their younger counterparts.2,4 For older sufferers with OAB, bladder sensation appears to be heightened, bladder capacities much lower, and urethral resistance rises in association with the onset of the condition, although the mechanism underlying this is unknown. Underlying mechanismsUrinary urgency in older people may be a result of both bladder and intracerebral lesions. Severity of urinary urgency and of incontinence per se have been associated with increased white matter hyperintensities (WMH) on MRI scanning of older people, suggesting that increasing ischemic insults in association with aging may impair higher centres of influence on the maintenance of continence, manifesting as severe urge, urgency and urgency incontinence. 5,6 Treatment of OAB in older patientsConventional treatment for OAB with conservative and lifestyle measures in combination with antimuscarinic pharmacotherapy is effective in older people. In direct contradiction to the usual geriatric paradigms of prescribing, older people: are more likely than young to require, and ask for, medication for their bladder problem; 7 appear to require higher doses of medication; 8,9 and, despite higher reported rates of adverse events, are more adherent to their medication than younger users. 10 Antimuscarinic...

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Efficacy and Tolerability of Fesoterodine in Older and Younger Subjects With Overactive Bladder

Cited by 57 publications

References 26 publications

Flexible‐Dose Fesoterodine in Elderly Adults with Overactive Bladder: Results of the Randomized, Double‐Blind, Placebo‐Controlled Study of Fesoterodine in an Aging Population Trial

Flexible‐Dose Fesoterodine in Elderly Adults with Overactive Bladder: Results of the Randomized, Double‐Blind, Placebo‐Controlled Study of Fesoterodine in an Aging Population Trial

Antimuscarinic Drugs: Review of the Cognitive Impact When Used to Treat Overactive Bladder in Elderly Patients

Treating overactive bladder in the elderly

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