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      Duloxetine versus placebo for the treatment of women with stress predominant urinary incontinence in Taiwan: a double-blind, randomized, placebo-controlled trial

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          Abstract

          Background

          This manuscript compares the efficacy and safety of duloxetine with placebo in Taiwanese women with SUI.

          Methods

          Taiwanese women with SUI were were randomly assigned to placebo (n = 61) or duloxetine 80 mg/day (n = 60) in this double-blind, 8-week, placebo-controlled study. Outcome variables included: incontinence episode frequency (IEF), Incontinence Quality of Life questionnaire (I-QOL) scores, and Patient Global Impression of Improvement rating (PGI-I).

          Results

          Decrease in IEF was significantly greater in duloxetine-treated than placebo-treated women (69.98% vs 42.56%, P < .001). No treatment differences in I-QOL scores were significant. There were significant differences in PGI-I rating. Treatment-emergent adverse events (TEAEs) were experienced by more duloxetine-treated than placebo-treated women (80.0% vs 44.3%; P < .001). Discontinuations due to adverse events were significantly greater for duloxetine-treated than placebo-treated women (26.7% vs 6.6%; P = .003).

          Conclusion

          Data provide evidence for the safety and efficacy of duloxetine for the treatment for Taiwanese women with SUI.

          Trial Registration

          ClinicalTrials.gov Identifier: NCT00475358

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          Most cited references34

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          Validation of two global impression questionnaires for incontinence.

          The purpose of this study was to assess the construct validity of two global assessment questions, the Patient Global Impression of Severity and of Improvement, in female patients with stress urinary incontinence. This was a secondary analysis of data from two double-blind, placebo-controlled studies that evaluated duloxetine for the treatment of predominant stress urinary incontinence in the United States (n = 1133 patients). Assessment variables included incontinence episode frequency, the Incontinence Quality of Life Questionnaire results, fixed volume (400 mL) stress pad test results, and the Patient Global Impression of Improvement and of Severity question results. Spearman correlation coefficients were 0.36, 0.20, and -0.50 among the Patient Global Impression of Severity question and incontinence episode frequency, stress pad test, and Incontinence Quality of Life Questionnaire results, respectively (all P <.0001). Mean incontinence episode frequency and median stress pad test results increased and mean Incontinence Quality of Life Questionnaire results decreased with increasing Patient Global Impression of Severity question severity levels. Similarly, significant (P <.0001) correlations were observed between the Patient Global Impression of Improvement question response categories and the three independent measures of improvement in stress urinary incontinence (0.49, 0.33, and -0.43 with incontinence episode frequency, stress pad test, and Incontinence Quality of Life Questionnaire results, respectively). As with the Patient Global Impression of Severity question, differences in mean changes for Incontinence Quality of Life Questionnaire and median percent changes for incontinence episode frequency and stress pad test among the Patient Global Impression of Improvement question response categories were highly significant (P <.0001). These relationships indicate appropriate and significant associations between the Patient Global Impression of Severity and of Improvement questions and the three independent measures of stress urinary incontinence severity and improvement, respectively. The Patient Global Impression of Severity and of Improvement question responses were correlated significantly with incontinence episode frequency, stress pad test, and Incontinence Quality of Life Questionnaire measures, which established the construct validity of these two global assessment questions for baseline severity and treatment response, respectively.
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            Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups.

            To measure the functional status and well-being of patients with chronic fatigue syndrome (CFS), and compare them with those of a general population group and six disease comparison groups. The subjects of the study were patients with CFS (n = 223) from a CFS clinic, a population-based control sample (n = 2,474), and disease comparison groups with hypertension (n = 2,089), congestive heart failure (n = 216), type II diabetes mellitus (n = 163), acute myocardial infarction (n = 107), multiple sclerosis (n = 25), and depression (n = 502). We measured functional status and well-being using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), which is a self-administered questionnaire in which lower scores are indicative of greater impairment. Patients with CFS had far lower mean scores than the general population control subjects on all eight SF-36 scales. They also scored significantly lower than patients in all the disease comparison groups other than depression on virtually all the scales. When compared with patients with depression, they scored significantly lower on all the scales except for scales measuring mental health and role disability due to emotional problems, on which they scored significantly higher. The two SF-36 scales reflecting mental health were not correlated with any of the symptoms of CFS except for irritability and depression. Patients with CFS had marked impairment, in comparison with the general population and disease comparison groups. Moreover, the degree and pattern of impairment was different from that seen in patients with depression.
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              Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument (I-QOL)

              To report on the further development of the Incontinence Quality of Life Instrument (I-QOL), a self-report quality of life measure specific to urinary incontinence (UI), including its measurement model, responsiveness, and effect size. Incontinent female patients (141 with stress, 147 with mixed UI) completed the I-QOL and comparative measures at screening, pretreatment, and four subsequent follow-up visits during participation in a multicenter, double-blind, placebo-controlled, randomized trial assessing the efficacy of duloxetine. Psychometric testing followed standardized procedures. Factor analysis confirmed an overall score and three subscale scores (avoidance and limiting behaviors, psychosocial impacts, and social embarrassment). All scores were internally consistent (alpha = 0.87 to 0.93) and reproducible (ICC = 0.87 to 0.91). The pattern of previously reported correlations with the Short-Form 36-item Health Survey and Psychological Well-Being Schedule were confirmed. Responsiveness statistics using changes in the independent measures of stress test pad weight, number of incontinent episodes, and patient global impression of improvement ranged from 0.4 to 0.8. Minimally important changes ranged from 2% to 5% in association with these measures and effect sizes. In a clinical trial, the I-QOL proved to be valid, reproducible, and responsive to treatment for UI in women.
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                Author and article information

                Journal
                BMC Urol
                BMC Urology
                BioMed Central
                1471-2490
                2008
                25 January 2008
                : 8
                : 2
                Affiliations
                [1 ]Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
                [2 ]Division of Urogynecology and Pelvic Reconstructive, Department of Obstetric and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
                [3 ]Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
                [4 ]Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
                [5 ]Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Lin-Kou, Taiwan
                [6 ]Medical Department, Eli Lilly and Company, Taiwan
                [7 ]Lilly Research Laboratories, Indianapolis, IN, USA
                Article
                1471-2490-8-2
                10.1186/1471-2490-8-2
                2266773
                18221532
                170aa3a8-8bc1-462b-87c7-49b07530da56
                Copyright © 2008 Lin et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 June 2007
                : 25 January 2008
                Categories
                Research Article

                Urology
                Urology

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