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86 THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.2 Jun. 30 2013
Bödeker RH et al. 發表以隨機雙盲試驗報告,1658位受試者參與 trospium 15 mg tid (N=828) 和 oxybutynin IR 2.5 mg tid (N=830) 試驗,治療4週後,trospium 組及 oxybutynin IR 組各別有29.2%及23.3%病人需加倍劑量,加倍劑量的兩組受試者,對減少每週尿
失禁次數的成效皆有提升。但經過12週治療後,服用 trospium 或 oxybutynin IR 各組中不論劑量有無調整,彼此在減少每週尿失
生,trospium 組發生加重口乾之比例低於oxybutynin IR 組 (p < 0.001)10。
F e s o t e r o d i n e 口服後於體內代謝成5-hydroxymethyl tolterodine (5-HMT),其抗膽鹼效力和 tolterodine 一樣。透過雙盲隨機試驗,分析 fesoterodine 臨床療效與劑量耐受性之差異,883位參與者每天服用 fesoterodine 4 mg 或安慰劑,1週後,63% fesoterodine 組劑量增加至8 mg 和73%安慰組亦增加劑量,治療12星期後,接受 fesoterodine 治療者在減少排尿、頻尿次數及改善急迫性症狀等療效評估成效皆優於安慰
90 THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.2 Jun. 30 2013
臨 床 藥 物 治 療 學 Therapeutics of Clinical Drugs
繼續教育
組。Fesoterodine 引起之口乾 (26% vs 8%)、便秘 (11% vs 6%) 等常見副作用的發生率也高於安慰劑組11。
Fesoterodine 和 tolterodine ER 統合分析 (meta-analysis) 研究結果,以 fesoterodine 8 mg 治療相較於 tolterodine ER 4 mg 可顯著改善急迫性排尿次數 (p < 0.05) 及每次解尿量
1. Abrams P, Andersson KE, Birder L, et al: Fourth Interna-tional Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 2010;29:213-240.
2. Chapple CR, Khullar V, Gabriel Z, et al: The Effects of Antimuscarinic Treatments in Overactive Bladder: An Update of a Systematic Review and Meta-Analysis. Euro-pean Urology 2008;54:543-562.
3. Madhuvrata P, Cody JD, Ellis G, et al: Which anticho-linergic drug for overactive bladder symptoms in adults. Cochrane Database of Systematic Reviews 2012; Issue 1. Art. No.: CD005429.
4. Chapple CR, Khullar V, Gabriel Z, et al: A systematic review and meta-analysis of randomized controlled trials with antimuscarinic drugs for overactive bladder. Euro-pean Urology 2008;54:740-764.
5. Roxburgh C, Cook J, Dublin N: Anticholinergic drugs versus other medications for overactive bladder syndrome in adults. Cochrane Database of Systematic Reviews 2009; Issue 1. Art. No.: CD003190.
6. Staskin DR, Dmochowski RR, Sand PK, et al: Efficacy and safety of oxybutynin chloride topical gel for overac-tive bladder: a randomized, double-blind, placebo con-trolled, multicenter study. J Urol 2009;181:1764-72.
7. Chapple CR, Martinez-Garcia R, Selvaggi L, et al: A com-parison of the efficacy and tolerability of solifenacin suc-cinate and extended release tolterodine at treating overac-tive bladder syndrome: results of the STAR trial. Eur Urol 2005;48:464-70.
8. Herschorn S, Pommerville P, Stothers L, et al: Tolerability of solifenacin and oxybutynin immediate release in older (>65 years) and younger (≦65 years) patients with over-active bladder: sub-analysis from a Canadian, randomized, double-blind study. Curr Med Res Opin 2011; 27:375-382.
9. Staskin DR, Rosenberg MT, Sand PK, et al: Trospium chloride once-daily extended release is effective and well tolerated for the treatment of overactive bladder syn-drome: an integrated analysis of two randomised, phase III trials. Int J Clin Pract 2009; 63:1715-23.
10. Bödeker RH, Madersbacher H, Neumeister C, et al: Dose escalation improves therapeutic outcome: post hoc analy-sis of data from a 12-week, multicentre, double-blind, parallel-group trial of trospium chloride in patients with urinary urge incontinence. BMC Urol 2010;10:15.
11. Dmochowski RR, Peters KM, Morrow JD, et al: Random-ized, double-blind, placebo-controlled trial of flexible-dose fesoterodine in subjects with overactive bladder. Urology 2010;75:62-68.
12. Chapple C, Van Kerrebroeck P, Tubaro A, et al: Clini-cal efficacy, safety and tolerability of once-daily fe-soterodine in subjects with overactive bladder. Eur Urol 2007;52:1204-12.
13. Zinner N, Tuttle J, Marks L: Efficacy and tolerability of darifenacin, amuscarinic M3 selective receptor antago-nist (M3 SRA), compared with oxybutynin in the treat-ment of patients with overactive bladder. World J Urol 2005;23:248-52.
92 THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.2 Jun. 30 2013
臨 床 藥 物 治 療 學 Therapeutics of Clinical Drugs
繼續教育
Anticholinergic Drugs for Treating Overactive Bladder
Chao-Chih Lo1, Tzu-Cheng Tsai2
Department of Pharmacy, Linkou Chang Gung Memorial Hospital1
Pharmacy Headquarters, Chang Gung Memorial Hospital2
Abstract
Overactive bladder (OAB) is a common chronic disease which interfere personal quality of life and result in a great impact. Patients often suffer from inconvenient urinary urgency and incontinence. Muscarinic receptor antagonists are the drug of mainstream therapy, such as oxybutynin, tolterodine, solifenacin, fesoterodine, and trospium. The therapeutic effects and side effects may depend on the specificity of cholinergic receptor, different formulation (immediate-released or extended released), dose, and route of administration of these agents. The purpose of this study is to investigate how these discrepancies influence the choice of treatment by systematic review and meta-analysis of randomized controlled trials. In contrast to immediate-release form, extended-release form provides more evidence of efficiency and safety. High dose regimen may accompany with potential side effects. If we concern these important clinical issues, such as efficiency, safety, and tolerability, further evaluation is necessary by evidence-based medicine and proposes a recommendation of the optimal drug therapy.