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Management of Overactive Bladder

Defining the Role of Extended-Release Tolterodine

  • Drugs in Disease Management
  • Published:
Disease Management & Health Outcomes

Abstract

Overactive bladder (OAB), a common condition affecting ≈16–17% of adult men and women in Europe and the US, is characterized by symptoms of urinary urgency, with or without urge urinary incontinence (UUI), usually with micturition frequency and nocturia. OAB is thought to result from abnormal, involuntary detrusor contractions during bladder filling. The symptoms of OAB have a considerable adverse effect on quality of life (QOL) in affected patients, and are associated with an increased risk of comorbidities, and increased direct and indirect costs.

Management of OAB focuses on symptom improvement, and includes nonpharmacologic and pharmacologic therapy. Extended-release tolterodine (Detrusitol® XL, Detrol LA®, Detrusitol SR®, Detrusitol® Neo, Detrusitol® Retard, Unidet™) is an oral, once-daily, nonselective, competitive antimuscarinic drug. It acts on smooth muscle motor efferent pathways, including bladder detrusor muscle, and is a first-line therapy for OAB. Extended-release tolterodine is at least as effective as immediate-release tolterodine in improving UUI and other symptoms associated with OAB (including urinary frequency, urgency symptoms, voided volume/micturition), and in improving health-related QOL. It has similar efficacy to oral immediate- or extended-release oxybutynin, or transdermal oxybutynin.

The likelihood of dry mouth, the most bothersome anticholinergic adverse effect associated with antimuscarinic drugs, is significantly reduced with extended-release tolterodine in patients with OAB compared with immediate-release tolterodine. Dry mouth also occurs significantly less frequently with extended-release tolterodine than with immediate- or extended-release oxybutynin. The incidence of dry mouth with extended-release tolterodine or transdermal oxybutynin is similar.

In economic models, extended-release tolterodine is more cost effective in patients with OAB than no treatment, or treatment with immediate-release tolterodine or immediate-release oxybutynin, and is as cost effective as extended-release oxybutynin.

In conclusion, clinical and economic data support the use of extended-release tolterodine as a first-line therapy in the management of adult patients with OAB. It is at least as effective as immediate-release tolterodine, but is associated with a lower incidence of dry mouth. Moreover, the convenient once-daily administration regimen offers the potential for good compliance. The favorable efficacy and tolerability profile of extended-release tolterodine has been demonstrated for up to 12 months. Extended-release tolterodine is as effective as oral immediate- or extended-release oxybutynin, but is better tolerated in terms of dry mouth. It has similar efficacy and tolerability (including dry mouth) to transdermal oxybutynin. Extended-release tolterodine is, therefore, a valuable first-line therapy in the treatment of OAB.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Authors and Affiliations

  1. Adis International Inc., 770 Township Line Road, Suite 300, Yardley, Pennsylvania, PA 19067, USA

    Susan J. Keam & Caroline M. Perry

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  1. Susan J. Keam
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  2. Caroline M. Perry
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Correspondence to Susan J. Keam.

Additional information

Various sections of the manuscript reviewed by: J.D. Bentkover, Innovative Health Solutions Corp., Brookline, Massachusetts, USA; C.R. Chapple, Department of Urology, Royal Hallamshire Hospital, Sheffield, England; G.-D. Chen, Department of Obstetrics and Gynecology, Chung Shan Medical University, Taichung, Taiwan; R.M. Freeman, Urogynaecology Unit, Directorate of Obstetrics and Gynaecology, Derriford Hospital, Plymouth, United Kingdom; P. Herbison, Department of Preventative and Social Medicine, Dunedin School of Medicine, Dunedin, New Zealand; S. Swift, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA; J.-J. Wyndaele, Department of Urology, University Hospital Antwerp, Edegem, Belgium.

Data Selection

Sources: Medical literature published in any language since 1980 on tolterodine, identified using Medline, supplemented by AdisBase (a proprietary database of Adis International). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.

Search strategy: Medline search terms were ‘urinary incontinence’ or ‘overactive bladder’ and (‘guidelines’ or ‘decision-making’ or ‘health-policy’ or ‘managed-care-programmes’ or ‘epidemiology’ or ‘outcome-assessment-health-care’ or ‘clinical-protocols’ or ‘guideline in pt’ or ‘polic* in ti’ or ‘expert panel’ or ‘utilization review’ or ‘algorithms’ or ‘disease management’ or ‘quality of life’), or ‘tolterodine’ and ‘review in pt’. AdisBase search terms were ‘urinary incontinence’ or ‘overactive bladder’ and (‘guideline’ or ‘guideline-utilisation’ or ‘practice-guideline’ or ‘disease-management-programmes’ or ‘treatment-algorithms’ or ‘reviews-on-treatment’ or ‘drug-evaluations’ or ‘epidemiology’ or ‘cost-of-illness’ or ‘pathogenesis’), or ‘tolterodine’ and (‘review’ or ‘clinical-study’). Searches were last updated 19 February 2004.

Selection: Studies in patients with overactive bladder who received the once-daily extended release formulation of tolterodine. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic, pharmacokinetic, pharmacoeconomic and epidemiologic data are also included.

Index terms: Overactive bladder, tolterodine, extended-release tolterodine, antimuscarinic agents, disease management, review on treatment.

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Keam, S.J., Perry, C.M. Management of Overactive Bladder. Dis-Manage-Health-Outcomes 12, 121–142 (2004). https://doi.org/10.2165/00115677-200412020-00005

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