Solifenacin (Vesicare®)is a new generation antimuscarinic, recently licensed for the treatment of overactive bladder. The product license was granted based upon the S.T.A.R Study - but do the results shine?
Well, yes and no is the honest answer. Vesicare was statistically better in terms of urgency episodes and incontinence episodes over 24 hours compared to Tolterodine XL. How this translates in clinical practice is difficult to see when give a 6.01% reduction in urgency episodes compared to a 5.84% reduction with Tolterodine XL.
But this is not the whole story, the promotional material makes no reference to side effects of the new drug, this is unusual as the number of patients who have tried the drug will be quite small and therefore the drug should have few reported side effects. When referring to the trial paper there may be a reason why. Patients treated with Vesicare were more likely to get dry mouth and constipation when compared to Tolterodine XL. Statistical analysis was not carried out on these data so significance is unknown, but the relative risk of side effects is 16.6% higher with Vesicare.
Action: Given the marginal clinical benefit of Vesicare balanced with the greater likelihood of side effects this drug is not appropriate for first line use in patients with overactive bladder. It may be of use in those patients who feel their symptoms are still problematic following treatment with Tolterodine XL.
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