Botulinum A toxin/dimethyl sulfoxide bladder instillations for women with refractory idiopathic detrusor overactivity: A phase 1/2 study

Steven P. Petrou, Alexander Parker, Juliana Crook, Alexandra Rogers, Dorothea Metz-Kudashick, David D. Thiel

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Abstract

We completed a phase 1/2 trial to evaluate the safety and potential efficacy of direct intravesical instillation of a botulinum type A toxin/dimethyl sulfoxide (DMSO) solution for treatment of idiopathic detrusor overactivity in women. Twenty-five women with medication-resistant, urodynamic-confirmed idiopathic detrusor overactivity were enrolled. A total of 9 patients were treated in phase 1 of the study. Three patients were given a 66% dosing of solution; 22 patients received the full 300 units of botulinum toxin and 50 mL of DMSO (50% concentration). Adverse effects, 24-hour pad weights, episodes of incontinence, postvoid residuals, and scores on the Blaivas-Groutz anti-incontinence scale, Indevus Urgency Severity Scale, Incontinence Impact Questionnaire-short form, and Urogenital Distress Inventory (6 items) questionnaire were recorded at baseline, 1 month, and 3 months after instillation. No serious adverse effects or clinically important increases in postvoid residual occurred. Among the 21 women who completed phase 2 of the study, the median number of incontinent episodes decreased from 4 at baseline to 2 at 1 month (P=.004) and increased to 4 at 3 months (P=.81). Median scores improved from baseline to 1 month on the Incontinence Impact Questionnaire (from 13 to 7; P=.007) and Urogenital Distress Inventory (from 10 to 5; P=.003). Although 11 women (52%) reported severe urgency based on the Indevus Urgency Severity Scale at baseline, only 1 (5%; P<.001) and 3 (14%; P=.004) women reported severe scores at 1 and 3 months, respectively. Direct instillation of botulinum toxin/DMSO solution is safe. Its promising clinical effect warrants further evaluation in a randomized, placebo-controlled phase 3 setting.

Original languageEnglish (US)
Pages (from-to)702-706
Number of pages5
JournalMayo Clinic Proceedings
Volume84
Issue number8
DOIs
StatePublished - 2009

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Intravesical Administration
Type A Botulinum Toxins
Dimethyl Sulfoxide
Botulinum Toxins
Equipment and Supplies
Urodynamics
Placebos
Safety
Weights and Measures
Surveys and Questionnaires

ASJC Scopus subject areas

  • Medicine(all)

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Botulinum A toxin/dimethyl sulfoxide bladder instillations for women with refractory idiopathic detrusor overactivity : A phase 1/2 study. / Petrou, Steven P.; Parker, Alexander; Crook, Juliana; Rogers, Alexandra; Metz-Kudashick, Dorothea; Thiel, David D.

In: Mayo Clinic Proceedings, Vol. 84, No. 8, 2009, p. 702-706.

Research output: Contribution to journalArticle

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abstract = "We completed a phase 1/2 trial to evaluate the safety and potential efficacy of direct intravesical instillation of a botulinum type A toxin/dimethyl sulfoxide (DMSO) solution for treatment of idiopathic detrusor overactivity in women. Twenty-five women with medication-resistant, urodynamic-confirmed idiopathic detrusor overactivity were enrolled. A total of 9 patients were treated in phase 1 of the study. Three patients were given a 66{\%} dosing of solution; 22 patients received the full 300 units of botulinum toxin and 50 mL of DMSO (50{\%} concentration). Adverse effects, 24-hour pad weights, episodes of incontinence, postvoid residuals, and scores on the Blaivas-Groutz anti-incontinence scale, Indevus Urgency Severity Scale, Incontinence Impact Questionnaire-short form, and Urogenital Distress Inventory (6 items) questionnaire were recorded at baseline, 1 month, and 3 months after instillation. No serious adverse effects or clinically important increases in postvoid residual occurred. Among the 21 women who completed phase 2 of the study, the median number of incontinent episodes decreased from 4 at baseline to 2 at 1 month (P=.004) and increased to 4 at 3 months (P=.81). Median scores improved from baseline to 1 month on the Incontinence Impact Questionnaire (from 13 to 7; P=.007) and Urogenital Distress Inventory (from 10 to 5; P=.003). Although 11 women (52{\%}) reported severe urgency based on the Indevus Urgency Severity Scale at baseline, only 1 (5{\%}; P<.001) and 3 (14{\%}; P=.004) women reported severe scores at 1 and 3 months, respectively. Direct instillation of botulinum toxin/DMSO solution is safe. Its promising clinical effect warrants further evaluation in a randomized, placebo-controlled phase 3 setting.",
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