Overactive Bladder, Urge Urinary Incontinence
Conditions
Keywords
Female, Postmenopause
Brief summary
Overactive bladder (OAB) is an enigmatic condition that is treated symptomatically with anticholinergic drugs (gold standard 2013). In a clinical pilot study was found to be a trend for a higher reduction of the micturition frequency in the Bryophyllum pinnatum group - treated with chewing tablets containing 50% of dried BP leaf press juice - than in the placebo group (n=20, p=0.064) Hypothesis: To test the superior effectivity of Bryophyllum versus Placebo in the treatment of OAB with the needed number (Purpose 1) and to assess in an experimental arm the side effects of BP in comparison to the standard drug (Vesicare) in a clincial trial (Purpose 2).
Detailed description
* In a US nation-wide survey, lower urinary tract symptoms are one of the strongest predictors that patients will seek complementary and alternative medicine (CAM) care. In comparison to general gynecological patients, urogynecological patients are particularly prone to seek help in CAM. Moreover out of the different CAM options, herbal medication is one of the most preferred treatments. However, the effectiveness of CAM regarding OAB has not yet been adequately and objectively evaluated. Therefore, it is timely and essential to elucidate the mode of action as well as to prove efficacy of herbal treatments by a translational approach including comprehensive in vitro experimentation and randomized controlled clinical trials. Bryophyllum pinnatum and specially the flavonoid components have shown a muscle relaxing effect on porcine bladder strips. * Study Design: Multicenter, prospective, double-blind randomized, placebo-controlled cross-over study, phase III to test the superiority of Bryophyllum pinnatum (BP) over placebo in the treatment of overactive bladder. * In this cross-over trial a total of 30 patients is needed to proof the superiority of BP over placebo (5 randomization blocs, each 6 patients). Each patient gets each of the three study drugs (BP, Solifenacin, Placebo) in a double-blind randomization. The number of patients was calculated in a post-hoc analysis based on the primary endpoint of a previous study (reduction of micturition rates/24hours; 9.5 (SD2.2) before and 7.8 (SD1.2) after Bryophyllum versus 9.3 (SD1.8) before and 9.1(SD1.6) after placebo), under the assumption of a normal data distribution and a power of 80% a patient number of 2x20. Plus 10% for non-parametric tests in the case of a non-normal distribution (Wilcoxon) were added, what generated a number of 2x22 patients. * In order to facilitate an equality in the randomization, the investigator choose a cross-over design. Due to the length of the study time, the drop-out rate was risen from 10 to 20% what yielded under the assumption of a equal block randomization the number of 30 patients. Additionally, an explorative arm containing the standard medication Vesicare was inserted, as this is of great clinical interest. For this explorative comparative arm are no existing data that would allow to do a power calculation. * This follow-up study will give a compelling answer on the efficacy or non-efficacy of BP as well as the safety of BP in respect to placebo and possible answers of its position regarding the standard medication Vesicare.
Interventions
DRUGBryophyllum
Sponsors
PD Dr. med. Verena Geissbühler
Prof. pharm. Ursula von Mandach
Dr. med. David Scheiner
Dr. med. Matthias Werner
University of Zurich
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* OAB (\>8 micturitions/24 hours, associated with urge symptoms) * postmenopausal women * cystoscopy to exclude a bladder carcinoma or carcinoma in situ * written and oral informed consent
Exclusion criteria
* urinary tract infection in an intermittent catheter asservated sample (\>1000 bacterias/ml) * intake of bladder affecting drugs like anticholinergics, diuretics, muscle relaxing medications and phytotherapeutics in the last three months * neurological conditions such as stroke, multiple sclerosis, spinal cord injury or Parkinsons's disease * postvoid residual volume ≥100 ml * lactose intolerance * contraindication for Solifenacin
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change of the micturition frequency | participants will be followed for the duration of the study, an expected average of 35 weeks | assessment of the voiding frequency in the 3-day bladder at visit 2,3,4,5,6 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in quality of life parameters | participants will be followed for the duration of the study, an expected average of 35 weeks | assessment with quality of life and symptom burden questionnaires at visit 2,3,4,5,6 (questionnaires ICIQ-OAB and KHQ) |
| Voiding diary parameters | participants will be followed for the duration of the study, an expected average of 35 weeks | 3-day bladder diary returned at visit 2,3,4,5,6 |
| Assessments of the patient's compliance | participants will be followed for the duration of the study, an expected average of 35 weeks | drug intake protocol and counting of the returned tablets |
| Assessment of AE/SAE | participants will be followed for the duration of the study, an expected average of 35 weeks | AE/SAE protocol |
Countries
Switzerland
Outcome results
None listed