Trospium for Urinary Incontinence

Overseen By Becky Clarkson, PhD

Age: 18+

Sex: Female

Trial Phase: Phase 4

Sponsor: Becky Clarkson

Must not be taking: Anticholinergics

Disqualifiers: Impaired mobility, Neurological condition, Prolapse, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how trospium, a medication for overactive bladder, can assist women with urgency urinary incontinence, characterized by a sudden, strong need to urinate. Researchers aim to determine if trospium improves bladder control and affects brain activity related to bladder function. Participants will receive either trospium or a placebo (a harmless pill with no active ingredients) for 12 weeks, then switch. Women experiencing urinary incontinence at least five times a week, despite treatment for over three months, might be suitable candidates. As a Phase 4 trial, this research seeks to understand how this FDA-approved and effective treatment can benefit more patients.

Will I have to stop taking my current medications?

If you are currently taking anticholinergic medications, you will need to stop them for 4 weeks before joining the trial. The protocol does not specify other medication restrictions, but any drug interactions or expected medication changes during the study may affect eligibility.

What is the safety track record for these treatments?

Research has shown that trospium often treats symptoms of an overactive bladder, such as frequent urination or accidental leaks. This indicates it is generally well-tolerated by those using it for these issues. Trospium has been available for a long time and has FDA approval for treating overactive bladder.

Most people do not experience serious side effects, though some may have dry mouth, constipation, or headaches. These side effects are common with medications that help control bladder problems.

Since this trial is in a later phase, strong evidence supports the safety of trospium. Treatments in this phase have usually already demonstrated relative safety in earlier studies. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Trospium is unique because it targets urinary incontinence by blocking certain receptors in the bladder, reducing muscle spasms. Unlike many standard treatments that primarily focus on hormonal pathways or involve surgery, Trospium is an anticholinergic medication that works directly on the bladder muscle, aiming to decrease urgency and frequency. Researchers are excited about Trospium because it offers a non-invasive option with the potential for fewer systemic side effects, making it a promising alternative for individuals who have not found relief with traditional therapies.

What is the effectiveness track record for trospium in treating urinary incontinence?

Research shows that trospium effectively treats symptoms of an overactive bladder, such as sudden urges to urinate and accidental leaks. Studies have found that trospium significantly reduces these leaks and helps relax bladder muscles. One study discovered that trospium works as well as another common treatment, oxybutynin, but with fewer side effects. This makes trospium a well-tolerated option for managing urinary issues. It has greatly improved bladder control, making it a reliable choice for treating urinary incontinence. Participants in this trial will receive either trospium followed by a placebo or a placebo followed by trospium, allowing for a comprehensive evaluation of its effectiveness. ^{1 6 7 8 9}

Who Is on the Research Team?

Becky Clarkson, PhD

Principal Investigator

University of Pittsburgh

Are You a Good Fit for This Trial?

This trial is for women over 60 with urgency urinary incontinence (UUI) or urge-predominant mixed incontinence, occurring at least five times a week for more than three months despite treatment. Participants must not have certain medical conditions like spinal cord injury, severe pelvic issues, or be on conflicting medications.

Inclusion Criteria

I have had frequent urges to urinate or accidents for more than 3 months, despite treatment.

I am 60 years old or older.

Exclusion Criteria

I have bowel control issues and symptoms of colitis or IBS.

I have had radiation in my pelvic area or have advanced cancer in my uterus or bladder.

I have previously been treated for urinary incontinence with Botox or nerve stimulation.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Evaluation

Evaluation including history, physical, incontinence evaluation, and brain MRI

1 week

1 visit (in-person)

Treatment Phase 1

Participants receive either placebo or trospium for 12 weeks

12 weeks

Regular visits for monitoring

Treatment Phase 2

Crossover to receive the alternate treatment (trospium or placebo) for 12 weeks

12 weeks

Regular visits for monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Placebo oral tablet
• Trospium

Trial Overview

The study tests the effectiveness of Trospium against a placebo in managing UUI symptoms and examines how the brain responds to these treatments using MRI scans. It's a randomized double-blind crossover trial, meaning participants will receive both the drug and placebo at different times without knowing which one they're taking.

How Is the Trial Designed?

Group I: Trospium/Placebo Experimental Treatment 2 Interventions

Trospium first for 12 weeks followed by Placebo for 12 weeks

Group II: Placebo/Trospium Experimental Treatment 2 Interventions

Placebo first for 12 weeks followed by Trospium for 12 weeks.

Trospium is already approved in United States, European Union for the following indications:

Approved in United States as Sanctura for:

• Overactive bladder syndrome (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency

Approved in European Union as Regurin for:

• Overactive bladder syndrome (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency

Who Is Running the Clinical Trial?

Becky Clarkson

Lead Sponsor

Trials

1

Recruited

220+

Neil M. Resnick

Lead Sponsor

Trials

1

Recruited

220+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Published Research Related to This Trial

Trospium chloride (Spazmex) is effective in treating neurogenic overactive bladder in patients with Parkinson's disease, as shown by a significant reduction in urination frequency and improvement in quality of life over a 52-week treatment period involving 60 patients.

Long-term use of trospium chloride does not negatively impact cognitive functions, making it a safe first-line treatment option for urologic symptoms in Parkinson's disease patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Long-term safety and efficacy of trospium chloride for the treatment of neurogenic overactive bladder due to Parkinson's disease is there an effect on cognitive status?] Korshunova, ES., Andreev, MN., Korshunov, MN., et al.[2023]

Trospium chloride (Sanctura) is effective in relieving symptoms of overactive bladder (OAB) and has a favorable safety profile, with adverse events similar to placebo except for minor issues like dry mouth and constipation.

It is fast-acting and does not interact with other medications metabolized by cytochrome P450, making it a safe and convenient treatment option for the approximately 17% of US adults affected by OAB.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trospium chloride: an anticholinergic quaternary ammonium compound for the treatment of overactive bladder. Zinner, NR.[2019]

Trospium chloride, administered at 20 mg twice daily for 52 weeks, demonstrated significant efficacy in reducing micturition frequency, incontinence, and urgency events in patients with urge syndrome, with a notable increase in bladder capacity by 115 ml after treatment.

Trospium chloride had a better tolerability profile compared to oxybutynin, with lower rates of adverse events (64.8% vs. 76.7%) and a significantly reduced risk of dryness of the mouth, making it a safer option for long-term therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Controlled, double-blind, multicentre clinical trial to investigate long-term tolerability and efficacy of trospium chloride in patients with detrusor instability. Halaska, M., Ralph, G., Wiedemann, A., et al.[2022]

In a study involving 20 women with imperative voiding syndrome, the combination of Spasmex (trospium chloride) and alpha 1-adrenoblockers significantly improved clinical symptoms, with a twofold improvement observed after 4 weeks of treatment.

The treatment also increased the mean effective capacity of the urinary bladder by 25%, and it was well tolerated with no reported side effects, indicating its safety and efficacy for this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Combined treatment of voiding disorders in women with m-cholinolytic and alpha 1-adrenoblocker]. Danilov, VV., Vol'nykh, IIu., Abdullaeva, CK., et al.[2016]

Obesity is linked to a more severe state of overactive bladder (OAB), as shown in a study of 1,165 subjects, indicating that overweight and obese patients may experience worse symptoms.

Trospium chloride XR, taken once daily, was found to be significantly more effective than a placebo in reducing OAB symptoms, such as toilet voids and urgency, in obese patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Obesity is associated with a more severe overactive bladder disease state that is effectively treated with once-daily administration of trospium chloride extended release. Chancellor, MB., Oefelein, MG., Vasavada, S.[2013]

Non-invasive uroflowmetric monitoring shows that hyperactive bladder and stress urinary incontinence in women share similar functional disorders, indicating a need for comprehensive assessment before surgery.

Long-term treatment with M-cholinolytics, specifically spasmex (trospium chloride), is recommended for patients, as it has minimal side effects and significantly improves conditions for planning surgical interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[M-cholinolytic spasmex and its role in preoperative preparation of patients with urine incontinence]. Danilov, VV., Danilova, TI.[2013]

Trospium chloride is an effective treatment for overactive bladder symptoms, such as urge incontinence and urinary frequency, with a unique pharmacologic profile that sets it apart from other antimuscarinic agents.

The drug has a low incidence of central nervous system side effects, making it a safer option for patients, and it demonstrates quick onset of action for relieving urgency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trospium chloride: Distinct among other anticholinergic agents available for the treatment of overactive bladder. Staskin, DR.[2013]

In a large observational study involving 669 patients with idiopathic overactive bladder, an individualized dosing approach for trospium chloride was found to be effective and safe over a 12-week period.

Patients adjusted their doses based on treatment response and side effects, with the majority receiving doses between 45 mg and 60 mg per day, highlighting the importance of personalized treatment in managing symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[High doses of trospium chloride in patients with idiopathic overactive bladder. Data of large-scale, multicenter observational program Resource]. Krivoborodov, GG., Tur, EI., Efremov, NS., et al.[2017]

In a study using isolated human detrusor smooth muscle strips, trospium chloride and tolterodine were found to be more effective than oxybutynin and flavoxate in relaxing muscle tension caused by muscarinic stimulation, indicating their potential superiority in treating urinary incontinence.

All tested drugs, including flavoxate, oxybutynin, tolterodine, and trospium chloride, demonstrated concentration-dependent effects in reducing muscle contractions, with trospium chloride and tolterodine showing the most pronounced effects, supporting their use in managing overactive bladder symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Responses of isolated normal human detrusor muscle to various spasmolytic drugs commonly used in the treatment of the overactive bladder. Uckert, S., Stief, CG., Odenthal, KP., et al.[2015]

Citations

1.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/17632131/

Once daily trospium chloride is effective and well tolerated ...

Conclusions: Trospium once daily provided significant improvements in overactive bladder symptoms (frequency, urgency urinary incontinence and urgency).

2.

mayoclinic.org

mayoclinic.org/drugs-supplements/trospium-oral-route/description/drg-20066543

Trospium (oral route) - Side effects & dosage

It helps to relax the muscles in the bladder and reduce the daily episodes of incontinence. Trospium is a urinary antispasmodic agent. This ...

3.

sciencedirect.com

sciencedirect.com/science/article/pii/S2772973724006404

A historical perspective on anticholinergics in overactive ...

An RCT in 1995 found that Trospium and Oxybutynin are equally effective in NDO, with Trospium having fewer side effects [23] . An RCT in 2006 confirmed its ...

4.

clinicaltrials.gov

clinicaltrials.gov/study/NCT01089751?term=Trospium&rank=8

Efficacy of Sanctura XR (Trospium Chloride) for Reducing ...

This study will investigate the safety and efficacy of Sanctura XR ( trospium chloride ) daily in reducing urgency, urinary frequency and urinary urge ...

5.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10167789/

Oral anticholinergic drugs versus placebo or no treatment for ...

Efficacy and tolerance of trospium chloride in patients with motor urge incontinence - results of a randomised double-blind placebo-controlled study (Poster ...

6.

webmd.com

webmd.com/drugs/2/drug-91487-403/trospium-oral/trospium-oral/details

Trospium (Sanctura) - Uses, Side Effects, and More

Trospium is commonly used to treat overactive bladder, when you have an urgent need to pee even if your bladder is not full, wetting accidents.

7.

go.drugbank.com

go.drugbank.com/drugs/DB00209

Trospium: Uses, Interactions, Mechanism of Action

Trospium is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency.

8.

rxlist.com

rxlist.com/sanctura-drug.htm

Sanctura (Trospium Chloride Tablets): Side Effects, Uses, ...

Based on animal data, trospium chloride is predicted to have a low probability of increased risk of adverse developmental outcomes, above background risk.

9.

my.clevelandclinic.org

my.clevelandclinic.org/health/drugs/19898-trospium-tablets

Trospium (Sanctura): Uses & Side Effects

Trospium is a medication that treats an overactive bladder and wetting accidents. It works by reducing how often you pee.