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Urodynamic and Clinical Efficacy of Mirabegron for Neurogenic Bladder Patients

Primary Purpose

Urinary Bladder, Neurogenic

Status
Terminated
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Mirabegron
Placebo
Sponsored by
Lawson Health Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Urinary Bladder, Neurogenic focused on measuring Multiple Sclerosis, Spinal Cord Injuries, mirabegron, Urodynamics

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria:

  • Diagnosis of traumatic or nontraumatic suprasacral spinal cord injury (SCI) or multiple sclerosis (MS, based on a neurologist assessment and/or the McDonald criteria)(28)
  • Age >18 years
  • Stable method of bladder management for >3months (either spontaneous or provoked voiding, or intermittent catheterization).
  • Bothersome urinary symptoms (urinary frequency, urgency, or urgency incontinence based on standard ICS definitions(29)) and completed 3 day voiding diary demonstrating at least 1 episode of non-stress based urinary incontinence over the 72hr period (this may be urgency based incontinence or unaware incontinence).
  • Patient is able to read and speak English

Exclusion criteria:

Based on Screening visit history:

  • Participation in another drug or device study in the 60 days prior to the screening visit.
  • Previous urologic surgery: Transurethral prostatectomy, bladder augmentation, sphincterotomy, bladder neck sling, artificial urinary sphincter, catheterizable channel, implantable electrostimulator/neuromodulator
  • Current use of suprapubic catheter/foley catheter
  • Unstable cardiac disease (uncontrolled hypertension, myocardial infarction, unstable angina, severe congestive heart failure (NYHA 3 or 4), ventricular arrhythmia (such as torsades de pointes), or stroke within the last 6 months)
  • Clinically significant abnormal ECG
  • The investigator believes the patient has an increased risk of QT prolongation (based on review of the screening ECG and patients concurrent medications)
  • History of significant renal dysfunction within 1 year, or serum creatinine >150umol/L at screening visit (visit 1).
  • History of significant liver disease within 1 year, or serum AST/ALT >2 times upper limit of normal, GGT >3 times upper limit of normal, total bilirubin >2 times upper limit of normal at screening visit (visit 1).
  • History of pelvic radiation
  • History of bladder cancer
  • History of a concurrent malignancy or cancer (except noninvasive skin cancer) within the last 5 years. Subjects with a history of cancer are considered eligible if the subject has undergone potentially curative therapy and the subject has been considered disease free for at least 5 years (with the exception of basal cell or squamous cell carcinoma of the skin).
  • Patient has a history of interstitial cystitis/pelvic pain syndrome
  • Patient has a history of acute or chronic urinary retention within the last 3 months, and is currently not using intermittent catheters
  • Patient has a history of a tachyarrhythmia
  • Patient has a history of glaucoma
  • Patient has a medical condition that may cause noncompliance with the study protocol
  • In the opinion of the Investigator the patient has a history of significant stress urinary incontinence
  • Patient has signs and symptoms of an active urinary tract infection (symptoms of dysuria, foul smelling urine, cloudy urine, increased spasticity, increased autonomic dysreflexia, self reported fever, increased incontinence, back/suprapubic pain).

    o Patient will submit urine for culture and sensitivity, undergo treatment, and will be eligible for rescreening after treatment.

  • Female patient who is pregnant or breastfeeding, or plans to become pregnant.
  • Male patient who is planning on fathering a child during the study or for 28 days after the last dose of study drug, or who is planning to donate sperm
  • Patient refuses to provide written consent
  • Patient will be unable or unwilling to complete the questionnaires and study visits
  • In the opinion of the study investigator, it is not in the patient's best interest to be enrolled in this study.

Based on medication and allergy review

  • The new addition of an anticholinergic medication, or a change to anticholinergic dose, within the last 30 days, (bladder specific anticholinergics include oxybutynin, tolterodine, fesoterodine, solifenacin, darifenacin, trospium, hyoscine, oxybutynin gel or patch, atropine, benzatropine). If previously used and discontinued, these medications must have been stopped for >2 weeks
  • Newly added bladder active medication (or dose change) within the last 2 months (Tamsulosin, Silodosin, Terazosin, Baclofen, Diazepam, amitriptyline, Finasteride, Dutasteride, DDAVP/desmopressin)
  • Use of flecainide, propafenone, donepezil, thioridazine, tramadol, aripiprazole, desipramine, imipramine, venlafaxine or digoxin
  • Intravesical onabotulinum toxin use within the last 1 year
  • Intravesical oxybutynin within the last 3 months
  • Patient has a previous history of treatment with mirabegron
  • Patient has a known allergy to mirabegron or a previous adverse reaction to a beta 3 agonist.

Based on physical exam

  • Patient has a postvoid residual > 250mL at study enrollment after repeated tested (1 attempt to re-void to ensure complete emptying of the bladder) and is not using intermittent catheters
  • Patient has a resting BP >180 mmHg systolic and/or >110 mmHg diastolic after 2 minutes of sitting quietly
  • Patient has a resting heart rate >100bpm after 2 minutes of sitting quietly
  • In the opinion of the study investigator, it is not in the patient's best interest to be enrolled in this study based on a clinically significant abnormality on physical exam.

Sites / Locations

  • Rehabiliation Center, Health Sciences Center
  • Kingston General Hospital and Hotel Dieu Hospital (Queens University)
  • Western University
  • University of Ottawa
  • Toronto Western Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Mirabegron

Placebo

Arm Description

Patients randomised to this arm start with mirabegron 25mg PO daily for two weeks, and then at 2 weeks titrate to 50mg PO daily, and maintain that dose for the duration of the study (8 additional weeks).

Inert placebo pill, matching active treatment pill.

Outcomes

Primary Outcome Measures

Bladder Capacity
Urodynamic bladder capacity

Secondary Outcome Measures

3 Day Voiding Diary
The 3 day voiding diary is a simple patient maintained record of fluid intake, voided volume and incontinence episodes. This will be used to assess number of episodes of urgency incontinence, urinary frequency, longest time between voids, functional capacity, and mean voided volume
24hr Urinary Pad Weights
This will determine the amount of urinary incontinence that occurs over a 24hr period.
Quality of Life (Bladder Specific)
The Short Form-Qualiveen is a urinary specific quality of life measure developed and studied specifically for neurogenic bladder patients; validity, reliability and responsiveness have been established.
Quality of Life (Incontinence)
The I-QOL is an incontinence specific quality of life tool that has been shown to be a valid, reliable and responsive measurement among patients with neurogenic bladder dysfunction
Patient Reported Outcome Measure-NBSS
The Neurogenic bladder symptom score (NBSS) is a symptom specific measure of urinary symptoms developed for patients with neurogenic bladder dysfunction with demonstrated validity and reliability. Minimum score is 0, maximum score is 74. Higher score is worse neurogenic bladder symptoms.
Patient Perception of Bladder Condition
The patient perception of bladder condition is a commonly used measure in the assessment of oral medications for the treatment of overactive bladder symptoms
Adverse Events
Adverse events will be monitored passively. They will be actively monitored for hypertension, tachycardia, and urinary retention.
Secondary Urodynamic Characteristics: Maximum Detrusor Pressure
Secondary Urodynamic Characteristics: Volume at Maximum Detrusor Pressure
Secondary Urodynamic Characteristics: Bladder Sensation
Secondary Urodynamic Characteristics: Bladder Compliance
Secondary Urodynamic Characteristics: Volume at First Detrusor Overactivity

Full Information

First Posted
January 22, 2014
Last Updated
January 15, 2019
Sponsor
Lawson Health Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT02044510
Brief Title
Urodynamic and Clinical Efficacy of Mirabegron for Neurogenic Bladder Patients
Official Title
A Double Blind, Randomized Placebo Controlled Trial Evaluating the Urodynamic and Clinical Efficacy of Mirabegron Among Neurogenic Bladder Patients
Study Type
Interventional

2. Study Status

Record Verification Date
January 2019
Overall Recruitment Status
Terminated
Why Stopped
Slow recruitment and small observed effect size
Study Start Date
July 2014 (Actual)
Primary Completion Date
January 2018 (Actual)
Study Completion Date
February 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Lawson Health Research Institute

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The proposed study is a randomized, double blind placebo controlled multicenter study to determine the effectiveness of mirabegron in the treatment of neurogenic bladder dysfunction. Patients will be randomized into one of two trial arms: mirabegron 25mg for two weeks, with escalation to 50mg for the remaining 8 weeks, or matched placebo capsule for two weeks, with placebo escalation for the remaining 8 weeks. Each of these trial arms will be stratified based on whether the patient is already taking an anticholinergic medication or not. The study will treat a total of 144 patients (72 with placebo, 72 with mirabegron). The study hypothesis is that mirabegron will result in a statistically superior (increased) urodynamic bladder capacity. The study duration is 12 weeks, with a 1-4 week run in period where no active or placebo treatment will be administered. The primary outcome measure will be based on an increase in urodynamic bladder capacity. Secondary outcome measures will be additional urodynamic parameters, urinary symptom scales, urinary quality of life indices, and voiding diary results. Patients who are over 18 years of age with a diagnosis of multiple sclerosis (MS) or spinal cord injury (SCI) will be eligible to participate. All eligible patients will have urodynamic studies performed within 4 weeks of trial enrollment, and at the end of study (week 9-10). Adverse events and study outcomes will be assessed at predefined study time points.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Urinary Bladder, Neurogenic
Keywords
Multiple Sclerosis, Spinal Cord Injuries, mirabegron, Urodynamics

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
32 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Mirabegron
Arm Type
Experimental
Arm Description
Patients randomised to this arm start with mirabegron 25mg PO daily for two weeks, and then at 2 weeks titrate to 50mg PO daily, and maintain that dose for the duration of the study (8 additional weeks).
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Inert placebo pill, matching active treatment pill.
Intervention Type
Drug
Intervention Name(s)
Mirabegron
Other Intervention Name(s)
MYRBETRIQ
Intervention Description
Mirabegron 25mg PO daily for 2 weeks, with dose increase to Mirabegron 50mg PO daily for the remaining 8 weeks.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Matched placebo capsules to the intervention arm
Primary Outcome Measure Information:
Title
Bladder Capacity
Description
Urodynamic bladder capacity
Time Frame
10 weeks
Secondary Outcome Measure Information:
Title
3 Day Voiding Diary
Description
The 3 day voiding diary is a simple patient maintained record of fluid intake, voided volume and incontinence episodes. This will be used to assess number of episodes of urgency incontinence, urinary frequency, longest time between voids, functional capacity, and mean voided volume
Time Frame
10 weeks
Title
24hr Urinary Pad Weights
Description
This will determine the amount of urinary incontinence that occurs over a 24hr period.
Time Frame
10 weeks
Title
Quality of Life (Bladder Specific)
Description
The Short Form-Qualiveen is a urinary specific quality of life measure developed and studied specifically for neurogenic bladder patients; validity, reliability and responsiveness have been established.
Time Frame
10 weeks
Title
Quality of Life (Incontinence)
Description
The I-QOL is an incontinence specific quality of life tool that has been shown to be a valid, reliable and responsive measurement among patients with neurogenic bladder dysfunction
Time Frame
10 weeks
Title
Patient Reported Outcome Measure-NBSS
Description
The Neurogenic bladder symptom score (NBSS) is a symptom specific measure of urinary symptoms developed for patients with neurogenic bladder dysfunction with demonstrated validity and reliability. Minimum score is 0, maximum score is 74. Higher score is worse neurogenic bladder symptoms.
Time Frame
10 weeks
Title
Patient Perception of Bladder Condition
Description
The patient perception of bladder condition is a commonly used measure in the assessment of oral medications for the treatment of overactive bladder symptoms
Time Frame
10 weeks
Title
Adverse Events
Description
Adverse events will be monitored passively. They will be actively monitored for hypertension, tachycardia, and urinary retention.
Time Frame
10 weeks
Title
Secondary Urodynamic Characteristics: Maximum Detrusor Pressure
Time Frame
10 weeks
Title
Secondary Urodynamic Characteristics: Volume at Maximum Detrusor Pressure
Time Frame
10 weeks
Title
Secondary Urodynamic Characteristics: Bladder Sensation
Time Frame
10 weeks
Title
Secondary Urodynamic Characteristics: Bladder Compliance
Time Frame
10 weeks
Title
Secondary Urodynamic Characteristics: Volume at First Detrusor Overactivity
Time Frame
10 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Diagnosis of traumatic or nontraumatic suprasacral spinal cord injury (SCI) or multiple sclerosis (MS, based on a neurologist assessment and/or the McDonald criteria)(28) Age >18 years Stable method of bladder management for >3months (either spontaneous or provoked voiding, or intermittent catheterization). Bothersome urinary symptoms (urinary frequency, urgency, or urgency incontinence based on standard ICS definitions(29)) and completed 3 day voiding diary demonstrating at least 1 episode of non-stress based urinary incontinence over the 72hr period (this may be urgency based incontinence or unaware incontinence). Patient is able to read and speak English Exclusion criteria: Based on Screening visit history: Participation in another drug or device study in the 60 days prior to the screening visit. Previous urologic surgery: Transurethral prostatectomy, bladder augmentation, sphincterotomy, bladder neck sling, artificial urinary sphincter, catheterizable channel, implantable electrostimulator/neuromodulator Current use of suprapubic catheter/foley catheter Unstable cardiac disease (uncontrolled hypertension, myocardial infarction, unstable angina, severe congestive heart failure (NYHA 3 or 4), ventricular arrhythmia (such as torsades de pointes), or stroke within the last 6 months) Clinically significant abnormal ECG The investigator believes the patient has an increased risk of QT prolongation (based on review of the screening ECG and patients concurrent medications) History of significant renal dysfunction within 1 year, or serum creatinine >150umol/L at screening visit (visit 1). History of significant liver disease within 1 year, or serum AST/ALT >2 times upper limit of normal, GGT >3 times upper limit of normal, total bilirubin >2 times upper limit of normal at screening visit (visit 1). History of pelvic radiation History of bladder cancer History of a concurrent malignancy or cancer (except noninvasive skin cancer) within the last 5 years. Subjects with a history of cancer are considered eligible if the subject has undergone potentially curative therapy and the subject has been considered disease free for at least 5 years (with the exception of basal cell or squamous cell carcinoma of the skin). Patient has a history of interstitial cystitis/pelvic pain syndrome Patient has a history of acute or chronic urinary retention within the last 3 months, and is currently not using intermittent catheters Patient has a history of a tachyarrhythmia Patient has a history of glaucoma Patient has a medical condition that may cause noncompliance with the study protocol In the opinion of the Investigator the patient has a history of significant stress urinary incontinence Patient has signs and symptoms of an active urinary tract infection (symptoms of dysuria, foul smelling urine, cloudy urine, increased spasticity, increased autonomic dysreflexia, self reported fever, increased incontinence, back/suprapubic pain). o Patient will submit urine for culture and sensitivity, undergo treatment, and will be eligible for rescreening after treatment. Female patient who is pregnant or breastfeeding, or plans to become pregnant. Male patient who is planning on fathering a child during the study or for 28 days after the last dose of study drug, or who is planning to donate sperm Patient refuses to provide written consent Patient will be unable or unwilling to complete the questionnaires and study visits In the opinion of the study investigator, it is not in the patient's best interest to be enrolled in this study. Based on medication and allergy review The new addition of an anticholinergic medication, or a change to anticholinergic dose, within the last 30 days, (bladder specific anticholinergics include oxybutynin, tolterodine, fesoterodine, solifenacin, darifenacin, trospium, hyoscine, oxybutynin gel or patch, atropine, benzatropine). If previously used and discontinued, these medications must have been stopped for >2 weeks Newly added bladder active medication (or dose change) within the last 2 months (Tamsulosin, Silodosin, Terazosin, Baclofen, Diazepam, amitriptyline, Finasteride, Dutasteride, DDAVP/desmopressin) Use of flecainide, propafenone, donepezil, thioridazine, tramadol, aripiprazole, desipramine, imipramine, venlafaxine or digoxin Intravesical onabotulinum toxin use within the last 1 year Intravesical oxybutynin within the last 3 months Patient has a previous history of treatment with mirabegron Patient has a known allergy to mirabegron or a previous adverse reaction to a beta 3 agonist. Based on physical exam Patient has a postvoid residual > 250mL at study enrollment after repeated tested (1 attempt to re-void to ensure complete emptying of the bladder) and is not using intermittent catheters Patient has a resting BP >180 mmHg systolic and/or >110 mmHg diastolic after 2 minutes of sitting quietly Patient has a resting heart rate >100bpm after 2 minutes of sitting quietly In the opinion of the study investigator, it is not in the patient's best interest to be enrolled in this study based on a clinically significant abnormality on physical exam.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Blayne Welk, MD MSc
Organizational Affiliation
Western University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rehabiliation Center, Health Sciences Center
City
Winnipeg
State/Province
Manitoba
ZIP/Postal Code
R3A 1M4
Country
Canada
Facility Name
Kingston General Hospital and Hotel Dieu Hospital (Queens University)
City
Kingston
State/Province
Ontario
ZIP/Postal Code
K7L 5G2
Country
Canada
Facility Name
Western University
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 4V2
Country
Canada
Facility Name
University of Ottawa
City
Ottawa
State/Province
Ontario
ZIP/Postal Code
K1Y 4E9
Country
Canada
Facility Name
Toronto Western Hospital
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5T 2S8
Country
Canada

12. IPD Sharing Statement

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Urodynamic and Clinical Efficacy of Mirabegron for Neurogenic Bladder Patients

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