Oral Fesoterodine Fumarate Can Ease Bladder Problems in MS
Treatment with fesoterodine fumarate — which comes as an extended-release tablet patients can take by mouth — can reduce bladder pressure and improve quality of life in people with bladder impairments due to multiple sclerosis (MS) or spinal cord injuries, new research shows.
“A 3‐month treatment with fesoterodine fumarate … seems to have a critical impact on patients’ QoL [quality of life],” the investigators wrote, noting their study “revealed a significant increase in QoL in each group” of participants given the oral medicine.
The findings were published in Neurourology and Urodynamics, in a study titled “Efficacy of fesoterodine fumarate (8 mg) in neurogenic detrusor overactivity due to spinal cord lesion or multiple sclerosis: A prospective study.”
Most people with MS — up to 75% — will experience bladder-related health problems at some point in their lives, research shows.
In particular, people with MS and other forms of nerve damage may develop something called neurogenic overactive bladder or nOAB. This condition occurs when the bladder is overly active because of erroneous activity in the nervous system. Specifically, nOAB in MS tends to develop because the detrusor — the muscle around the bladder — is “squeezing” too much.
Such bladder-related problems can severely impact quality of life for patients, the researcher said.
“Urinary disorders, by the fear of urine leaking and its consequences, may affect sleeping time due to nocturia or even lead to isolation and avoid contact with other people,” they wrote. Nocturia is when a person wakes up during nighttime sleeping because of a need to urinate.
Fesoterodine fumarate, marketed as a long-acting tablet under the brand name Toviaz, works to block the molecular signals that tell the detrusor to “squeeze.” It is approved to treat overactive bladder when the cause isn’t clear, but there are little published data on the use of this medicine in people with neurogenic overactive bladder, specifically.
Now, researchers in Greece reported on 124 people with an overactive bladder due to nervous problems who were treated with fesoterodine fumarate at a dose of 8 mg per day for three months. About one-quarter of these patients had MS; the rest had spinal cord damage. The total group included 68 males and 56 females.
At the start and end of the study, the participants underwent detailed assessments of their bladder function. They also answered questionnaires about their quality of life, and kept daily diaries related to bladder function.
The results showed that the three-month treatment led to statistically significant improvements in many measures of bladder function. For example, it markedly reduced the maximum detrusor pressure — which, as its name suggests, is the highest amount of force that the detrusor puts on the bladder.
The treatment also increased the maximum amount the bladder could hold, and it significantly improved life quality.
Notably, these improvements were significant across disease subgroups — MS or spinal cord injury — and among people with different levels of physical ability, including those with minimal or no limb function (tetraplegics and quadriplegics).
“Fesoterodine fumarate (8 mg) is an efficacious [treatment] in patients with [spinal cord damage] and MS, as it significantly decreases the detrusor pressure, increases the bladder capacity and compliance, and improves the QoL,” the researchers concluded.
The study was limited by its lack of a placebo group, which made it impossible to discount the placebo effect as a potential explanation for the results, the researchers noted. Another limitation is that the researchers did not have comprehensive safety data for the treatment.
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