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Safety and Efficacy of Intravesical Botulinum Toxin in TC-3 Gel in OAB Patients

Primary Purpose

Overactive Bladder

Status
Terminated
Phase
Phase 1
Locations
Israel
Study Type
Interventional
Intervention
BTX mixed with TC-3 Gel
Sponsored by
UroGen Pharma Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Overactive Bladder focused on measuring overactive bladder, OAB, urgency, botulinum toxin, BTX, botox, intravesical, TheraCoat, TCGel, TC-3 Gel

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Female 18 to 85 years old with symptoms of idiopathic OAB for ≥ 3 months prior to screening.
  • Patient has signed Informed Consent Form and is willing and able to comply with all requirements of the protocol, including proper completion of the voiding diaries and self-administered questionnaires.
  • Patient is non-responder to anticholinergic or beta-agonist drug therapy or is not compliant to the treatment due has intolerable side effects.
  • Patient has urination frequency of at least 8 micturitions per 24 hours.
  • Patients has at least 3 urinary urgency incontinence (UUI) episodes per 3-day bladder diary, with no more than 1 incontinence-free day.
  • Patients has PVR ≤100 ml. Patient with a single PVR of >100 ml and followed by two consecutive PVR measurements of <100 ml may be included in the study).
  • If patient is a female of childbearing potential, she has a negative urine pregnancy test at screening visit and practice a reliable method of contraception throughout the study, until 6 months post treatment.
  • Patient is mentally competent with the ability to understand and comply with the requirements of the study.
  • Patient does not have active urinary tract infection as confirmed by urine culture. In case of UTI proven by urine culture, the patient will be treated with full course of antibiotics, and the instillation will be postponed for 1 week following negative urine culture demonstration.

Exclusion Criteria:

  • Pregnant (positive urine pregnancy test), planning to become pregnant during the study period, breast-feeding, or of childbearing potential and not practicing reliable contraception**.
  • Patient has a clinically significant Bladder Outlet Obstruction (BOO).
  • Patient has neurogenic bladder.
  • Patient currently uses Clean Intermittent Catheterization (CIC).
  • Patient has documented unstable diabetes with or without diabetic neuropathy.
  • Patient who is currently undergoing biofeedback, pelvic muscle rehabilitation, pelvic floor physical therapy, or electrical-stimulation.
  • Patient with 24-hour total urine volume voided greater than 3,000 ml as measured at screening period.
  • Patient with vesico-ureteral reflux, interstitial cystitis, genitourinary fistulae
  • Patient with pelvic organ prolapse stage III or IV, (i.e. the most distal part of the prolapse protruding more than 1 cm beyond the hymen at straining)
  • Patient with lower tract genitourinary malignancies
  • Patient with prior anti-incontinence surgery and interventions including mid-urethral slings, Burch bladder suspension, sacral neuromodulation, or tibial nerve stimulation.
  • Patient with prior Botox anti-incontinence therapy.
  • Patient with previous pelvic radiation therapy
  • Patient who is morbidly obese (BMI > 40 Kg/m2).
  • Patient had been treated for 2 or more UTIs within last 6 months.
  • Patient on immunomodulatory therapy (suppressive or stimulatory)
  • Patient participated in prior clinical trials with BTX+TC-3 gel
  • Patient has current major psychiatric disorder or other psychiatric or medical issues that would interfere with study participation (e.g. dementia, psychosis, upcoming major surgery, etc).
  • Subject has severe cardiac, pulmonary, renal, or hepatic disease that in the judgment of the study physician would preclude participation in this study.
  • Patient with a life expectancy of less than 12 months.

Sites / Locations

  • Urology Department, Edith Wolfson Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

BTX mixed with TC-3 Gel

Arm Description

Patients will be treated with a single intravesical instillation of 40 ml TC-3 gel mixed with 300U BTX

Outcomes

Primary Outcome Measures

Safety
Adverse events measured during entire study period. Adverse events will be graded according to the Common Toxicity Criteria on a scale of 0 to 5. Presence of the urinary retention defined as a PVR >200 ml.
Efficacy
Number of urinary urge episodes in 24-hour period per 3-day voiding diary (primary endpoint - week 12 post instillation) Proportion of patients who had positive treatment response per Treatment Benefit Scale (TBS) (primary endpoint - week 12 post instillation).

Secondary Outcome Measures

exploratory efficacy
Number of voids in 24-hour period per 3-day voiding diary (primary endpoint - week 12 post instillation) Number of urge incontinence episodes in 24-hour period per 3-day voiding diary (primary endpoint - week 12 post instillation) Number of nocturnal voids per night per 3-day voiding diary (primary endpoint - week 12 post instillation). Post Void Residual Volume (PVR) as measured by bladder ultrasonography (primary endpoint - week 12 post instillation) KHQ score (Kings Health Questionnaire) (primary endpoint - week 12 post instillation). I-QOL score (Incontinence Quality of Life questionnaire) (primary endpoint - week 12 post instillation).

Full Information

First Posted
June 29, 2014
Last Updated
February 28, 2016
Sponsor
UroGen Pharma Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT02179099
Brief Title
Safety and Efficacy of Intravesical Botulinum Toxin in TC-3 Gel in OAB Patients
Official Title
Pilot Study Evaluating Safety and Efficacy of Intravesical Instillations of Botulinum Toxin in TC-3 Gel in OAB Patients
Study Type
Interventional

2. Study Status

Record Verification Date
February 2016
Overall Recruitment Status
Terminated
Why Stopped
Decision to open a randomized controlled trial with two groups receiving different Botulinum Toxin in comparison to placebo group.
Study Start Date
July 2014 (undefined)
Primary Completion Date
November 2015 (Actual)
Study Completion Date
February 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
UroGen Pharma Ltd.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a single arm pilot study evaluating the feasibility and preliminary safety of a single intravesical instillation of TC-3 gel mixed with botulinum toxin (BTX) for symptomatic improvement in overactive bladder patients.
Detailed Description
BTX is considered as therapeutic option for overactive bladder (OAB). Randomized placebo-controlled studies have shown that BTX administered by intramural injection into the bladder wall in patients with OAB leads to significant improvement in urodynamic parameters and quality of life. (Schurch 2008). On the other hand, the animal study suggests that intravesically applied BTX acts to decrease frequency of bladder contraction by inhibiting sensory mechanism in the urothelium rather than directly through inhibition of the smooth muscle contraction. (Khera 2005). The efficacy of intravesical BTX instillation was only tested in a few open label trials for overactive bladder patients whereby the clinical improvement observed was short-lasting with a mean duration of 6.8 weeks (Petrou 2009, Krhut 2011). The short exposure duration of the urothelium to BTX could be one of the factors responsible for the lack of a sustained effect. TC-3 is a hydrogel with reverse thermal gelation properties that when mixed with BTX and instilled intravesically serves as the drug reservoir allowing for gradual release of BTX and thereby for its extended contact with bladder urothelium.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Overactive Bladder
Keywords
overactive bladder, OAB, urgency, botulinum toxin, BTX, botox, intravesical, TheraCoat, TCGel, TC-3 Gel

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
3 (Actual)

8. Arms, Groups, and Interventions

Arm Title
BTX mixed with TC-3 Gel
Arm Type
Experimental
Arm Description
Patients will be treated with a single intravesical instillation of 40 ml TC-3 gel mixed with 300U BTX
Intervention Type
Device
Intervention Name(s)
BTX mixed with TC-3 Gel
Other Intervention Name(s)
TCGel, TheraCoat hydrogel, Botox, botulinum toxin A, BTX
Intervention Description
Patients will be treated with a single intravesical instillation of 40 ml TC-3 gel mixed with 300U BTX
Primary Outcome Measure Information:
Title
Safety
Description
Adverse events measured during entire study period. Adverse events will be graded according to the Common Toxicity Criteria on a scale of 0 to 5. Presence of the urinary retention defined as a PVR >200 ml.
Time Frame
16 weeks
Title
Efficacy
Description
Number of urinary urge episodes in 24-hour period per 3-day voiding diary (primary endpoint - week 12 post instillation) Proportion of patients who had positive treatment response per Treatment Benefit Scale (TBS) (primary endpoint - week 12 post instillation).
Time Frame
16 weeks
Secondary Outcome Measure Information:
Title
exploratory efficacy
Description
Number of voids in 24-hour period per 3-day voiding diary (primary endpoint - week 12 post instillation) Number of urge incontinence episodes in 24-hour period per 3-day voiding diary (primary endpoint - week 12 post instillation) Number of nocturnal voids per night per 3-day voiding diary (primary endpoint - week 12 post instillation). Post Void Residual Volume (PVR) as measured by bladder ultrasonography (primary endpoint - week 12 post instillation) KHQ score (Kings Health Questionnaire) (primary endpoint - week 12 post instillation). I-QOL score (Incontinence Quality of Life questionnaire) (primary endpoint - week 12 post instillation).
Time Frame
16 weeks

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Female 18 to 85 years old with symptoms of idiopathic OAB for ≥ 3 months prior to screening. Patient has signed Informed Consent Form and is willing and able to comply with all requirements of the protocol, including proper completion of the voiding diaries and self-administered questionnaires. Patient is non-responder to anticholinergic or beta-agonist drug therapy or is not compliant to the treatment due has intolerable side effects. Patient has urination frequency of at least 8 micturitions per 24 hours. Patients has at least 3 urinary urgency incontinence (UUI) episodes per 3-day bladder diary, with no more than 1 incontinence-free day. Patients has PVR ≤100 ml. Patient with a single PVR of >100 ml and followed by two consecutive PVR measurements of <100 ml may be included in the study). If patient is a female of childbearing potential, she has a negative urine pregnancy test at screening visit and practice a reliable method of contraception throughout the study, until 6 months post treatment. Patient is mentally competent with the ability to understand and comply with the requirements of the study. Patient does not have active urinary tract infection as confirmed by urine culture. In case of UTI proven by urine culture, the patient will be treated with full course of antibiotics, and the instillation will be postponed for 1 week following negative urine culture demonstration. Exclusion Criteria: Pregnant (positive urine pregnancy test), planning to become pregnant during the study period, breast-feeding, or of childbearing potential and not practicing reliable contraception**. Patient has a clinically significant Bladder Outlet Obstruction (BOO). Patient has neurogenic bladder. Patient currently uses Clean Intermittent Catheterization (CIC). Patient has documented unstable diabetes with or without diabetic neuropathy. Patient who is currently undergoing biofeedback, pelvic muscle rehabilitation, pelvic floor physical therapy, or electrical-stimulation. Patient with 24-hour total urine volume voided greater than 3,000 ml as measured at screening period. Patient with vesico-ureteral reflux, interstitial cystitis, genitourinary fistulae Patient with pelvic organ prolapse stage III or IV, (i.e. the most distal part of the prolapse protruding more than 1 cm beyond the hymen at straining) Patient with lower tract genitourinary malignancies Patient with prior anti-incontinence surgery and interventions including mid-urethral slings, Burch bladder suspension, sacral neuromodulation, or tibial nerve stimulation. Patient with prior Botox anti-incontinence therapy. Patient with previous pelvic radiation therapy Patient who is morbidly obese (BMI > 40 Kg/m2). Patient had been treated for 2 or more UTIs within last 6 months. Patient on immunomodulatory therapy (suppressive or stimulatory) Patient participated in prior clinical trials with BTX+TC-3 gel Patient has current major psychiatric disorder or other psychiatric or medical issues that would interfere with study participation (e.g. dementia, psychosis, upcoming major surgery, etc). Subject has severe cardiac, pulmonary, renal, or hepatic disease that in the judgment of the study physician would preclude participation in this study. Patient with a life expectancy of less than 12 months.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ami Sidi, Prof MD
Organizational Affiliation
Wolfson Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Urology Department, Edith Wolfson Medical Center
City
Holon
Country
Israel

12. IPD Sharing Statement

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Safety and Efficacy of Intravesical Botulinum Toxin in TC-3 Gel in OAB Patients

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