Comparing bladder therapies for older women with urinary incontinence

Cognitive, Urinary, and Functional Trajectories of Older Women Using Pharmacologic Treatment Strategies for Urgency Incontinence

This study is testing whether two different bladder treatments can help older women with urinary incontinence feel better compared to a placebo.

Quick facts

• Phase: Phase 4
• Study type: Interventional
• Enrollment: 270 (estimated)
• Ages: 60 Years and up
• Sex: Female
• Sponsor: University of California, San Francisco (Academic / other)
• Locations: 2 sites (Palo Alto, California and 1 other locations)
• Trial ID: NCT05362292 on ClinicalTrials.gov

What this trial studies

The TRIUMPH study is a randomized, double-blinded, three-arm trial that aims to evaluate the effectiveness of anticholinergic bladder therapy compared to beta-3-adrenergic agonist therapy and a placebo in older women experiencing urgency-predominant urinary incontinence. Participants will be ambulatory women aged 60 and older with normal or mildly impaired cognitive function, who report significant incontinence episodes. The study will assess cognitive, urinary, and other aging-related functional outcomes over the course of the trial.

Who should consider this trial

Good fit: Ideal candidates for this study are ambulatory women aged 60 and older who experience urgency-predominant urinary incontinence.

Not a fit: Patients with a prior diagnosis of dementia or significantly impaired cognitive function may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could provide effective treatment options for older women suffering from urinary incontinence, improving their quality of life.

How similar studies have performed: Other studies have explored bladder therapies, but this specific comparison of anticholinergic versus beta-3-adrenergic agonist therapy in this demographic is relatively novel.

Eligibility criteria

Inclusion Criteria:

* Aged 60 years or older at the time of enrollment
* Female sex at birth, without surgical or hormonal gender re-assignment therapy
* Able to walk to the bathroom and use the toilet without assistance
* Report urinary incontinence starting at least 3 months prior to screening
* Report that at least half of incontinence episodes occur with a sudden or strong sensation of urgency
* Report 2 or more urgency incontinence episodes over a 7-day period
* Willing to provide informed consent and adhere to study procedures throughout the length of the study

Exclusion Criteria:

* Prior clinician diagnosis of dementia, or a Montreal Cognitive Assessment (MOCA) score of 17 or lower on screening cognitive evaluation
* Current use of anticholinergic, beta-3-adrenergic agonist, or other medication designed to improve urgency incontinence symptoms, or use in the past 1 month
* Initiation, discontinuation, or dose change of dementia medications (such as donepezil, galantamine, memantine, rivastigmine) in the past 1 month (but candidates on stable doses are eligible)
* Initiation, discontinuation, or dose change of other drugs with strong anticholinergic effects (based on the Beers List) in the past 1 month (but candidates on stable doses are eligible)
* Initiation, discontinuation, or dose change of other drugs that can affect urinary frequency, including diuretics, in the past 1 month (but candidates on stable doses are eligible)
* Current urinary tract infection (UTI) based on screening urinalysis and culture (but candidates can re-present for re-screening after undergoing treatment for UTI)
* History of allergy or sensitivity to either of the study medications or an ingredient in the placebo or study medication capsule
* Severe hepatic impairment (Child-Pugh score B or greater) or renal impairment (creatinine clearance \<30 mL/min) as a contraindication to both study medications
* Current bladder obstruction or urinary retention (defined by symptoms suggesting difficulty emptying the bladder in addition to postvoid residual urine volume greater than 150 cc by portable bladder ultrasound)
* Uncontrolled hypertension (based on measured systolic blood pressure greater than 180 or diastolic blood pressure greater than 110 mmHg) as a contraindication to beta-3-adrenergic therapy
* Self-reported history of gastric retention, uncontrolled narrow angle glaucoma, myasthenia gravis, severe ulcerative colitis, or toxic megacolon as contraindications for anticholinergic bladder therapy
* Use of drugs with adverse interactions with one of the study medications in the past 1 month, including potent CYP3A4 inhibitors, hepatic enzyme metabolism inducers, narrow therapeutic index drugs metabolized by CYP2D6, or intention to start taking one of these medications during the study treatment period
* History of bladder surgery, invasive intra-vesical therapy, or bulk bladder injections in the past 3 months (more remote surgery will not be exclusionary), or intention to undergo one of these procedures in the study treatment period
* Use of other specialized incontinence therapy (electrostimulation, pelvic physiotherapy, formal behavioral therapy overseen by certified practitioners) in the past 3 months (more remote therapy will not be exclusionary), or intention to undergo one of these procedures in the study treatment period
* Inability to sign informed consent or complete questionnaires, interviews, or study testing in English
* Other condition that would prevent the participant from completing study procedures, in the opinion of the investigators (e.g., uncontrolled psychosis)

Where this trial is running

Palo Alto, California and 1 other locations

• Stanford University — Palo Alto, California, United States (Recruiting)
• University of California San Francisco — San Francisco, California, United States (Recruiting)

Study contacts

• Principal investigator: Alison Huang, MD, MAS, MPhil — University of California, San Francisco
• Study coordinator: Alison Huang, MD, MAS, MPhil

Conditions Urinary Incontinence, Urge; Urinary Incontinence; Overactive Bladder; Incontinence, Urge; Incontinence, Urinary; Incontinence