Issue: June 2020
Perspective from Gerald B. Whitman, MD
Source: Press Release
Disclosures: Nguyen reports no relevant financial disclosures.
May 27, 2020
2 min read
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FDA approves treatment for form of bladder dysfunction in children

Issue: June 2020
Perspective from Gerald B. Whitman, MD
Source: Press Release
Disclosures: Nguyen reports no relevant financial disclosures.
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The FDA announced that it has approved Astellas Pharma’s VESIcare LS oral suspension for the treatment of neurogenic detrusor overactivity, or NDO, in children aged 2 years and older.

Initially approved in 2004, VESIcare (solifenacin succinate) tablets have been used to treat overactive bladders in adults aged 18 years and older, according to the FDA.

NDO is a form of bladder dysfunction resulting from a disease or injury in the nervous system, the agency noted. It causes overactivity of the bladder wall muscle, which normally relaxes to allow storage of urine. The overactivity results in sporadic bladder muscle contraction, which then increases pressure in the bladder and decreases the volume of urine the bladder can hold.

“This is the first FDA-approved treatment for NDO patients as young as 2 years of age,” Christine P. Nguyen, MD, acting director of FDA’s Division of Urology, Obstetrics and Gynecology, said in a statement. “In addition, prior to [the] approval, the current standard of care for many of these patients required up to three times a day dosing, and this treatment requires only once-a-day dosing.”

If NDO is not treated, increased pressure in the bladder can put the upper urinary tract at risk and can cause permanent damage to the kidneys, according to the FDA. NDO also can lead to frequent and unexpected leakage of urine with symptoms of urinary urgency, frequency and incontinence.

The dysfunction could be related to congenital conditions that occur before or at birth, such as spina bifida, or other conditions related to injuries to the spinal cord, the FDA noted.

Two clinical trials tested the efficacy of solifenacin succinate among a total of 95 pediatric NDO patients aged between 2 and 17 years. The studies were designed to measure the maximum amount of urine the bladder could hold after 24 weeks of treatment.

In the first study, 17 patients aged between 2 and 4 years were able to hold an average of 39 mL more urine than at the beginning of the study, according to the FDA release. In the second study, 49 patients aged between 5 and 17 years were able to hold an average of 57 mL more urine than at the beginning of the study.

“Reductions in spontaneous bladder contractions, bladder pressure and number of incontinence episodes were also observed in both studies,” the release stated.

Common side effects of solifenacin succinate are constipation, dry mouth and UTIs. Drowsiness also has been reported.

Health care professionals are advised not to exceed the recommended starting dose for patients also taking strong CYP3A4 inhibitors.