Treatment of Incontinence Without Memory Problems
Condition: Urge Incontinence; Urinary Incontinence, Urge
MeSH terms: Urinary Incontinence; Urinary Incontinence, Urge
Intervention: Mirabegron; Tolterodine Tartrate
Intervention MeSH terms: Mirabegron; Tolterodine Tartrate
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Enrollment: 23.0
Sex: Female
Minimum age: 65 Years
Healthy volunteers: Accepts Healthy Volunteers

Summary:

      An 8-week randomized, controlled, pilot clinical trial of Mirabegron compared to a standard
      anticholinergic therapy (Detrol LA) in elderly women with urgency urinary incontinence.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Community-dwelling, ambulatory females ≥ 65 years old

          -  Urgency or Mixed Urgency Predominate Urinary Incontinence (subject-reported) for ≥ 3
             months prior to Screening (Visit 1)

          -  On a 3-day voiding diary, documentation of at least 3 urgency incontinence episodes
             with the number of urgency incontinence episodes greater than number of stress
             incontinence episodes

          -  Capability of understanding and having signed the informed consent form after full
             discussion of the research nature of the treatment and its risk and benefits

          -  Ability to perform all procedures and tests required by the protocol

          -  Report having a primary health care provider

          -  Willingness to remain on stable medication regime for duration of the randomized
             controlled trial. Participants will be asked to not add new medications during the
             randomized controlled trial, such as diuretics and other medications which may affect
             their voiding pattern.

        Exclusion Criteria:

          -  Seated blood pressure >180/110 at Screening or Baseline

          -  Physician diagnosis of dementia

          -  Current use of dementia medications, debilitating or recent neurologic disease

          -  Mini Mental State Examination (MMSE) score <20

          -  History of urinary retention, gastric retention, uncontrolled narrow angle glaucoma,
             myasthenia gravis, severe ulcerative colitis, toxic megacolon, fistula or a hole in
             your bladder or rectum, birth defect leading to urine leakage, and urine leakage
             starting in childhood

          -  Clinically significant hepatic (Child Pugh B or greater) or renal (creatinin clearance
             <30 mL/min or eGFR <30 mL/min/1.73 m2)

          -  Neurologic conditions such as stroke, multiple sclerosis, spinal cord injury, or
             Parkinson's disease.

          -  Major cardiovascular even in the past 6 months (i.e., MI, unstable angina,
             hospitalization for chest pain)

          -  Symptomatic pelvic organ prolapse defined as participant report of feeling or seeing a
             bulge outside the vagina within the past 3 months.

          -  History of surgery for incontinence in the past 5 years, pelvic surgery the past 6
             months (i.e., for prolapse or hysterectomy), intra-vesical therapy (botox), and/or
             bulk injections within the past 6 months.

          -  A known history of interstitial cystitis or a significant pain component associated
             with OAB symptoms, uninvestigated hematuria, urogenital cancer, radiation to the
             pelvis or external genitalia.

          -  Urinary tract infection (UTI) as shown by the results of the urinalysis at screening
             or recurrent urinary tract infection (RUTIs) defined as treatment for UTI >3 times in
             the last year.

          -  Urinary retention (post-void residual urine volume >150 cc measured by Bladder scan at
             screening.

          -  Use of any electrostimulation, bladder training, or pelvic floor exercises (with
             certified incontinence practitioners) within 4 weeks of Screening.

          -  Received study medication in any previous mirabegron clinical trial.

          -  Prior failure for either efficacy or tolerability of ≥ 2 OAB medications in the last
             year. (Failure: inadequate symptom control after two medications for a minimum of one
             month each.)

          -  Has been treated within 2 weeks prior to Screening and/or is currently being treated
             with:

               -  Any drug treatment for OAB

               -  Any drugs with significant anticholinergic and antispasmodic effects (see
                  exception for tricyclic antidepressants below)

          -  Has started treatment with tricyclic antidepressants or estrogens within 4 weeks prior
             to Screening and/or is not on a stable dose.

          -  Intermittent use or unstable dose of diuretics. Treatment with diuretics initiated
             within 2 weeks prior to baseline and/or is not on a stable dose is not permitted.

          -  Treatment with potent CYP3A4 inhibitors, such as clarithromycin, ketoconazole, and
             itraconazole within 2 weeks prior to Screening.

          -  Administration of medications capable of inducing hepatic enzyme metabolism or
             transport (e.g., barbiturates, rifampicin, carbamazepine, phenytoin, primidone, or St.
             John's Wort) in the past 30 days.

          -  Administration of narrow therapeutic index drugs metabolized by CYP2D6, such as
             thioridazine, flecainide, and propafenone.

          -  Previously received any investigational drug within 30 days prior to trial entry.

          -  Alcohol and/or any other drug abuse in the opinion of the investigator.

          -  Participants who have any medical (including known history of major hematological,
             renal, cardiovascular, or hepatic abnormalities) or psychological condition or social
             circumstances that would impair their ability to participate reliably in the trial, or
             those who may increase the risk to themselves or others by participating.

          -  Participants who, in the opinion of the investigator, are not likely to complete the
             trial for whatever reason.