First stress incontinence drug launched
Duloxetine (Yentreve) is the first drug to be marketed for treatment of stress urinary incontinence (SUI) in women.
It is a serotonin and noradrenaline reuptake inhibitor, thought to act
centrally to enhance urethral sphincter tone and contraction. This can
prevent leakage of urine brought about by sudden rises in abdominal pressure,
as with coughing, laughing or exercise.
Clinical trials have shown reduction in the frequency of incontinence
(50 per cent or greater median decrease compared with 33 per cent with
placebo) and improvement in quality of life scores. The drug is licensed
for patients with moderate to severe SUI. In mild SUI (fewer than 14
episodes per week) there was no clear benefit.
The most common side effect is nausea, reported in 23 per cent of women.
In clinical trials, nausea developed early in treatment, resolving within
a month in most patients.
Linda Cardozo, professor of urogynaecology, King’s College Hospital,
London, believes that women will not choose to take the drug long term
but might take it until they make lifestyle changes, or perhaps while
on the waiting list for surgery; it is, she said, also suitable for women
who want more children, for whom traditional SUI surgery may be less
appropriate.
SUI is most common in younger and middle aged women, while urge incontinence
(treated with antimuscarinics) is more common in the elderly.
Duloxetine, which is being co-marketed by Lilly and Boehringer Ingelheim,
is also being developed as an antidepressant.
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