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Tolterodine extended release in the treatment of male OAB/storage LUTS: a systematic review.

Gacci M, Novara G, De Nunzio C, Tubaro A, Schiavina R, Brunocilla E, Sebastianelli A, Salvi M, Oelke M, Gravas S, Carini M, Serni S - BMC Urol (2014)

Bottom Line: A 71% mean reduction in urgency incontinence episodes was found in the tolterodine ER group compared to a 60% reduction in the tolterodine IR (p < 0.05).A recent meta-analysis evaluating tolterodine in comparison with other antimuscarinic drugs demonstrated that tolterodine ER was significantly more effective than placebo in reducing micturition/24 h, urinary leakage episodes/24 h, urgency episodes/24 h, and urgency incontinence episodes/24 h.Tolterodine ER resulted effective in reducing frequency urgency and nocturia and urinary leakage in male patients with OAB/storage LUTS.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Florence, Careggi Hospital, Viale S, Luca - 50134, Florence, Italy. maurogacci@yahoo.it.

ABSTRACT

Background: Overactive bladder (OAB)/ storage lower urinary tract symptoms (LUTS) have a high prevalence affecting up to 90% of men over 80 years. The role of sufficient therapies appears crucial. In the present review, we analyzed the mechanism of action of tolterodine extended-release (ER) with the aim to clarify its efficacy and safety profile, as compared to other active treatments of OAB/storage LUTS.

Methods: A wide Medline search was performed including the combination of following words: "LUTS", "BPH", "OAB", "antimuscarinic", "tolterodine", "tolterodine ER". IPSS, IPSS storage sub-score and IPSS QoL (International Prostate Symptom Score) were the validated efficacy outcomes. In addition, the numbers of urgency episodes/24 h, urgency incontinence episodes/24 h, incontinence episodes/24 h and pad use were considered. We also evaluated the most common adverse events (AEs) reported for tolterodine ER.

Results: Of 128 retrieved articles, 109 were excluded. The efficacy and tolerability of tolterodine ER Vs. tolterodine IR have been evaluated in a multicenter, double-blind, randomized placebo controlled study in 1529 patients with OAB. A 71% mean reduction in urgency incontinence episodes was found in the tolterodine ER group compared to a 60% reduction in the tolterodine IR (p < 0.05). Few studies evaluated the clinical efficacy of α-blocker/tolterodine combination therapy. In patients with large prostates (prostate volume >29 cc) only the combination therapy significantly reduced 24-h voiding frequency (2.8 vs. 1.7 with tamsulosin, 1.4 with tolterodine, or 1.6 with placebo). A recent meta-analysis evaluating tolterodine in comparison with other antimuscarinic drugs demonstrated that tolterodine ER was significantly more effective than placebo in reducing micturition/24 h, urinary leakage episodes/24 h, urgency episodes/24 h, and urgency incontinence episodes/24 h. With regard to adverse events, tolterodine ER was associated with a good adverse event profile resulting in the third most favorable antimuscarinic. Antimuscarinic drugs are the mainstay of pharmacological therapy for OAB / storage LUTS; several studies have demonstrated that tolterodine ER is an effective and well tolerated formulation of this class of treatment.

Conclusion: Tolterodine ER resulted effective in reducing frequency urgency and nocturia and urinary leakage in male patients with OAB/storage LUTS. Dry mouth and constipation are the most frequently reported adverse events.

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Related in: MedlinePlus

Forest plots of efficacy and safety after IR and ER tolterodine. 3a: micturitions/24 Hrs; 3b: volume voided per micturition; 3c: dry mouth; 3d: headache. (License number 3340911442671 of Mar 2, 2014 between Elsevier and Dr. G. Novara).
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Fig2: Forest plots of efficacy and safety after IR and ER tolterodine. 3a: micturitions/24 Hrs; 3b: volume voided per micturition; 3c: dry mouth; 3d: headache. (License number 3340911442671 of Mar 2, 2014 between Elsevier and Dr. G. Novara).

Mentions: A recent network meta-analysis evaluating tolterodine in comparison with other antimuscarinic drugs demonstrated that tolterodine ER was significantly more effective than placebo in reducing micturition/24 h (-0.76; p <0.001), urinary leakage episodes/24 h (-0.36; p <0.001), urgency episodes/24 h (-0.77; p <0.001), and urgency incontinence episodes/24 h (-0.34; p <0.001) [48]. With regard to adverse events, the same article demonstrated that tolterodine ER was associated with a good adverse event profile resulting in the third most favorable antimuscarinic out of 21 analyzed antimuscarinic drugs, following oxybutynin topical gel 100 mg/g per day and solifenacin 5 mg per day [50] (Figure 2).Figure 2


Tolterodine extended release in the treatment of male OAB/storage LUTS: a systematic review.

Gacci M, Novara G, De Nunzio C, Tubaro A, Schiavina R, Brunocilla E, Sebastianelli A, Salvi M, Oelke M, Gravas S, Carini M, Serni S - BMC Urol (2014)

Forest plots of efficacy and safety after IR and ER tolterodine. 3a: micturitions/24 Hrs; 3b: volume voided per micturition; 3c: dry mouth; 3d: headache. (License number 3340911442671 of Mar 2, 2014 between Elsevier and Dr. G. Novara).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230346&req=5

Fig2: Forest plots of efficacy and safety after IR and ER tolterodine. 3a: micturitions/24 Hrs; 3b: volume voided per micturition; 3c: dry mouth; 3d: headache. (License number 3340911442671 of Mar 2, 2014 between Elsevier and Dr. G. Novara).
Mentions: A recent network meta-analysis evaluating tolterodine in comparison with other antimuscarinic drugs demonstrated that tolterodine ER was significantly more effective than placebo in reducing micturition/24 h (-0.76; p <0.001), urinary leakage episodes/24 h (-0.36; p <0.001), urgency episodes/24 h (-0.77; p <0.001), and urgency incontinence episodes/24 h (-0.34; p <0.001) [48]. With regard to adverse events, the same article demonstrated that tolterodine ER was associated with a good adverse event profile resulting in the third most favorable antimuscarinic out of 21 analyzed antimuscarinic drugs, following oxybutynin topical gel 100 mg/g per day and solifenacin 5 mg per day [50] (Figure 2).Figure 2

Bottom Line: A 71% mean reduction in urgency incontinence episodes was found in the tolterodine ER group compared to a 60% reduction in the tolterodine IR (p < 0.05).A recent meta-analysis evaluating tolterodine in comparison with other antimuscarinic drugs demonstrated that tolterodine ER was significantly more effective than placebo in reducing micturition/24 h, urinary leakage episodes/24 h, urgency episodes/24 h, and urgency incontinence episodes/24 h.Tolterodine ER resulted effective in reducing frequency urgency and nocturia and urinary leakage in male patients with OAB/storage LUTS.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Florence, Careggi Hospital, Viale S, Luca - 50134, Florence, Italy. maurogacci@yahoo.it.

ABSTRACT

Background: Overactive bladder (OAB)/ storage lower urinary tract symptoms (LUTS) have a high prevalence affecting up to 90% of men over 80 years. The role of sufficient therapies appears crucial. In the present review, we analyzed the mechanism of action of tolterodine extended-release (ER) with the aim to clarify its efficacy and safety profile, as compared to other active treatments of OAB/storage LUTS.

Methods: A wide Medline search was performed including the combination of following words: "LUTS", "BPH", "OAB", "antimuscarinic", "tolterodine", "tolterodine ER". IPSS, IPSS storage sub-score and IPSS QoL (International Prostate Symptom Score) were the validated efficacy outcomes. In addition, the numbers of urgency episodes/24 h, urgency incontinence episodes/24 h, incontinence episodes/24 h and pad use were considered. We also evaluated the most common adverse events (AEs) reported for tolterodine ER.

Results: Of 128 retrieved articles, 109 were excluded. The efficacy and tolerability of tolterodine ER Vs. tolterodine IR have been evaluated in a multicenter, double-blind, randomized placebo controlled study in 1529 patients with OAB. A 71% mean reduction in urgency incontinence episodes was found in the tolterodine ER group compared to a 60% reduction in the tolterodine IR (p < 0.05). Few studies evaluated the clinical efficacy of α-blocker/tolterodine combination therapy. In patients with large prostates (prostate volume >29 cc) only the combination therapy significantly reduced 24-h voiding frequency (2.8 vs. 1.7 with tamsulosin, 1.4 with tolterodine, or 1.6 with placebo). A recent meta-analysis evaluating tolterodine in comparison with other antimuscarinic drugs demonstrated that tolterodine ER was significantly more effective than placebo in reducing micturition/24 h, urinary leakage episodes/24 h, urgency episodes/24 h, and urgency incontinence episodes/24 h. With regard to adverse events, tolterodine ER was associated with a good adverse event profile resulting in the third most favorable antimuscarinic. Antimuscarinic drugs are the mainstay of pharmacological therapy for OAB / storage LUTS; several studies have demonstrated that tolterodine ER is an effective and well tolerated formulation of this class of treatment.

Conclusion: Tolterodine ER resulted effective in reducing frequency urgency and nocturia and urinary leakage in male patients with OAB/storage LUTS. Dry mouth and constipation are the most frequently reported adverse events.

Show MeSH
Related in: MedlinePlus