The findings, “Randomized, controlled trial of fesoterodine fumarate for overactive bladder in Parkinson’s disease” were published in the World Journal of Urology.
Although a high percentage (27% to 80%) of Parkinson’s patients experience lower urinary tract problems, little is known about effective treatments. Urinary symptoms such as urgency, frequency, nocturia (excessive urination at night), dysuria (pain or discomfort when urinating), and incontinence are indicative of an overactive bladder and can affect patients’ quality of life considerably.
A class of medications known as antimuscarinic drugs has been shown to effectively reduce overactive bladder symptoms. However, these medicines also affect the central nervous system and cognitive function. Antimuscarinics target receptors in the bladder’s smooth muscle, suppressing premature contractions and enhancing urine storage.
To date, there are not enough randomized controlled trials to allow doctors to confidently prescribe antimuscarinic treatment to manage lower urinary tract symptoms in Parkinson’s disease.
A team of Turkish researchers now evaluated the short-term effectiveness and safety of fesoterodine fumarate in Parkinson’s patients with overactive bladder symptoms. Fesoterodine fumarate is the active substance in Toviaz (fesoterodine) a medication for overactive bladder that also is an antimuscarinic treatment.
Sixty-three Parkinson’s patients (32 women and 31 men, aged between 46 and 87 years) with troublesome bladder problems were included in the randomized, double-blind and placebo-controlled study. Participants were first randomly assigned to either fesoterodine fumarate 4 mg (32 subjects) or placebo (31 subjects) for four weeks. This was followed by a one-week washout period and a four-week open-label extension phase in which all patients, including those who were on placebo previously, received 4 mg daily of fesoterodine fumarate.
“The researchers and the participants were unaware of the content of medication,” the team noted.
At the beginning of the study, most participants (96.8%) had urgency incontinence and 4.7% of them also reported stress incontinence.
Following the first four weeks of treatment, the average daily number of urinations significantly decreased in the fesoterodine fumarate group, compared to the control sample (7.9 versus 18.7 urination episodes in 24 hours). Participants on fesoterodine also had their nocturia and urgency episodes reduced.
Four patients on the fesoterodine fumarate group recovered from urgency urinary incontinence and patients on placebo maintained their urinary complaints.
By the end of the open-label phase of the study, overactive bladder treatment was found to significantly decrease the number of urinations, urgency and urgency urinary incontinence episodes. The number of nocturia episodes remained unchanged.
Because of the previously described risk for cognitive impairment following antimuscarinic treatment, researchers evaluated the patients’ cognitive status, using the widely used Mini Mental State Examination (MMSE). Cognition was stable after one month of treatment.
The therapy was well-tolerated and caused no serious side effects. However, one patient on fesoterodine experienced dryness of the mouth and one other reported constipation, which resolved after treatment discontinuation.
“While short-term results from this study are encouraging, further studies with long-term follow-up are needed to evaluate the efficacy and safety of fesoterodine fumarate in PD [Parkinson’s disease] patients with OAB [overactive bladder],” the researchers concluded.