Fesoterodine: Individualised Treatment of Urgency Urinary Incontinence Across Patient Groups

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 efficacymay 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. (C) 2011 Published by Elsevier B. V. on behalf of European Association of Urology.