Duloxetine versus placebo in the treatment of European and Canadian women with stress urinary incontinence

Objective To assess the efficacy and safety of duloxetine in women with stress urinary incontinence. Design Randomised double-blind, placebo-controlled clinical trial. Setting Fort-six centres in seven European countries and Canada. Population Four hundred and ninety-four women aged 24-83 years identified as having predominant symptoms of stress urinary incontinence using a clinical algorithm that was 100% predictive of urodynamic stress urinary incontinence in a subgroup of 34 women. Methods The case definition included a predominant symptom of stress urinary incontinence with a weekly incontinence episode frequency greater than or equal to7, the absence of predominant symptoms of urge incontinence, normal diurnal and nocturnal frequencies, a bladder capacity greater than or equal to400 mL and both a positive cough stress test and positive stress pad test. Subjects completed two urinary diaries prior to randomisation and three diaries during the active treatment phase of the study, each completed during the week prior to monthly visits. Subjects also completed quality of life questionnaires at each visit. Safety was assessed by the evaluation of treatment-emergent adverse events, discontinuation of treatment because of adverse events, serious adverse events, vital sign measurements, electrocardiograms (ECG) and clinical laboratory tests. Intervention After a two-week placebo lead-in, women received placebo or duloxetine 40 mg BD for 12 weeks. Main outcome measures The percentage decrease in incontinence episode frequency and the change in the Incontinence Quality of Life (I-QOL) questionnaire total score were prespecified as co-primary outcome variables in the protocol. Results Incontinence episode frequency decreased significantly with duloxetine compared with placebo (median decrease of 50% vs 29%; P = 0.002) with comparable improvements in the more severely incontinent subgroup (those experiencing at least 14 incontinence episodes per week at baseline; 56% vs 27% decreases; P < 0.001). The primary analysis of I-QOL scores did not reveal a significant difference between treatment groups, due primarily to the carrying forward of low scores from patients who discontinued treatment very early due to duloxetine-associated adverse events. The increase in I-QOL scores was significantly greater for duloxetine than for placebo at each of the three postrandomisation visits after 4, 8, and 12 weeks of treatment. Discontinuation rates for adverse events were higher for duloxetine (22% vs 5%: P < 0.001) with nausea being the most common reason for discontinuation (5.3%). Nausea tended to be mild to moderate, not progressive, and transient. Conclusions The findings support duloxetine as a potential treatment for women with stress urinary incontinence.