Safety and Effectiveness of a Non-invasive Neuromodulation Device on Urgency Urinary Incontinence in Overactive Bladder

Ethicon Endo-Surgery163 enrolled

Overview

The purpose of this study is to evaluate the change from baseline between the active and sham treatment groups in the treatment of urgency (urinary) incontinence episodes (leaks).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

163

Conditions

Overactive Bladder

Interventions

(VERV™ System)DEVICE

Active electrode patches are worn for 12 weeks, one per week. The patch is placed by the subject. All subjects will have access to active patches for 9 months after the sham-controlled 12-week portion of the study is complete.

Sham version of (VERV™ System)DEVICE

Inactive (sham) electrode patches are worn for 12 weeks, one per week. The patch is placed by the subject. All subjects will have access to active patches for 9 months after the sham-controlled 12-week portion of the study is complete.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Males and Females, at least 18 years of age * Failure on primary OAB treatment, such as behavior modification or fluid/diet management, AND at least one (1) anti-cholinergic drug (unless patient was contra-indicated for anti-cholinergic use) * Symptoms of overactive bladder for at least 6 months * An average of one (1) or more urgency (urinary) incontinence episodes per 24-hours, over a 3-day period, confirmed by the 3-day baseline voiding diary, with a maximum of 12 urgency (urinary) incontinence episodes per 24-hours * Dexterity and ability to place and operate the device * Females of child-bearing capability agrees to use a reliable form of birth control for the duration of the trial * An average of eight (8) or more voids per 24-hours, over a 3-day period, confirmed by the 3-day baseline voiding diary * Willing and capable of understanding and complying with all requirements of the protocol, including proper completion of the baseline voiding diary * Signed and dated the IRB-approved Informed Consent document. Exclusion Criteria: * Dysfunctional voiding symptoms unrelated to OAB, such as clinically significant bladder outlet obstruction, and urinary retention (pvr \> 100 cc) * Morbidly obese, defined as having Body Mass Index (BMI) \> 40 kg/m2 * Stress predominant mixed urinary incontinence * Neurological disease affecting urinary bladder function, including but not limited to Parkinson's disease, multiple sclerosis, stroke, spinal cord injury and uncontrolled epilepsy. * Pelvic surgery (such as sub-urethral sling, pelvic floor repair) within the past 6 months * Intravesical or urethral sphincter Botulinum Toxin Type A injections within the past 12 months * Any neuromodulation therapy for overactive bladder within the past 3 months * Failure to respond to previous neuromodulation therapy for overactive bladder * Leading edge of any vaginal prolapse is beyond hymenel ring. * Prior peri-urethral or transurethral bulking agent injections for bladder problems within the past 12 months. * Any skin conditions affecting treatment or assessment of the treatment sites * History of lower back surgery or injury that could impact placement of the patch, or where underlying scar tissue or nerve damage may impact treatment. * Presence of an implanted electro-medical device (e.g. pacemaker, defibrillator, InterStim®, etc.), or any metallic implant in the lower back. * Pregnant, nursing, suspected to be pregnant (by urine pregnancy method), or plans to become pregnant during the course of the study. * Known latex allergies, or allergies or hypersensitivity to patch materials that will be in contact with the body (e.g., hydrogel, acrylic-based adhesive, polyurethane). * Uncontrolled diabetes and/or diabetes with peripheral neuropathy. * Current Urinary Tract Infection (UTI) or history of recurrent UTIs (\>3 UTIs in the past year). * History of lower tract genitourinary malignancies within the last 6 months or any previous pelvic radiation. * Any clinically significant systemic disease or condition that in the opinion of the Investigator would make the patient unsuitable for the study.

Locations (14)

Arizona Urologic Specialists

Tucson, Arizona, United States

Tri Valley Urology Medical Group

Murrieta, California, United States

Outcomes

Primary Outcomes

Evaluate Proportion of Responders Based on the Change From Baseline in Mean Urgency (Urinary) Incontinence Episodes (Leaks) Between the Active and Sham Treatment Groups

The primary objective of the randomized phase of the study is to evaluate the 12 week change from baseline in mean urgency (urinary) incontinence episodes (leaks) between the active and sham treatment groups. The mean of the number of urinary incontinence episodes over 24 hours" is defined as the mean of the number of UIEs recorded per 24 hour period for three consecutive days (via a 3-day diary). The primary objective of the open label phase of the study is to evaluate and confirm the continued efficacy of the VERV™ System for long-term use. The primary objective was assessed with rate of responders, where responder was defined as a subject who achieved a decrease of ≥50% in mean urgency urinary incontinence episodes at 12 weeks compared to baseline.

Time frame: 12 weeks (Randomized Phase) and 12 Months (Open Label)

Evaluate the Median Change From Baseline in Mean Urgency (Urinary) Incontinence Episodes (Leaks) Between the Active and Sham Treatment Groups

The primary objective of the randomized phase of the study is to evaluate the 12 week and 12 month median change from baseline in mean urgency (urinary) incontinence episodes (leaks) between treatment groups. The mean of the number of urinary incontinence episodes over 24 hours" is defined as the mean of the number of UIEs recorded per 24 hour period for three consecutive days (via a 3-day diary). Mean urinary frequency episodes calculated for each patient during time period. The median change in frequency was then calculated for each treatment group. Distribution of changes from baseline were then assessed prospectively for normality using the Kolmogorov - Smirnoff test. Since departure from normality was actually observed in the distribution, the Wilcoxon Rank-Sum test was performed to compare the median change between treatment groups and the p-values for the test of equality of medians were reported along with the medians.

Time frame: 12 weeks (Randomized Phase) and 12 Months (Open Label)

Secondary Outcomes

Measure Change in the Median of the Mean Urinary Frequency

Data from ClinicalTrials.gov

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GW Medical Faculty Associates

Washington D.C., District of Columbia, United States

Specialists in Urology

Naples, Florida, United States

Urology Center of Florida

Pompano Beach, Florida, United States

Women's Health Institute of Illlinois, Ltd

Oak Lawn, Illinois, United States

1st Urology, PSC dba Metropolitan Urology

Jeffersonville, Indiana, United States

William Beaumont Hospital

Royal Oak, Michigan, United States

University Urology Associates

New York, New York, United States

McKay Urology

Charlotte, North Carolina, United States

...and 4 more locations

Evaluate the 12 week change from baseline in median urinary frequency between the active and sham treatment groups. Mean urinary frequency episodes calculated for each patient during time period. The median change in frequency was then calculated for each treatment group. Distribution of changes from baseline were then assessed prospectively for normality using the Kolmogorov - Smirnoff test. Since departure from normality was actually observed in the distribution, the Wilcoxon Rank-Sum test was performed to compare the median change between treatment groups and the p-values for the test of equality of medians were reported along with the medians.

Time frame: 12 weeks and 12 Months

Measure Median Change in Mean Volume Per Void

Evaluate the 12 week median change from baseline in mean volume (ml) per void between the active and sham treatment groups

Time frame: 12 weeks

Measure Decrease in the Median Change From Baseline in Mean Urgency Episodes

Evaluate the 12 week change from baseline in median for mean number of urgency episodes between the active and sham treatment groups. Patients were required to complete seven 3-day voiding diaries throughout the course of the study. The voiding diary collected the following information: amount voided (in ml); urgency associated with each toileted void , approximate time of leak, and presence of urge preceding leak.The mean number of urgency episodes over 24 hours was then calculated for each patient during the observation period. The change in median for the mean of the number of urgency episodes over 24 hours) for each treatment group was then calculated. Distribution of changes from baseline were assessed prospectively using the Kolmogorov - Smirnoff test. The Wilcoxon Rank-Sum test was performed to compare the median change between treatment groups and the p-values for the test of equality of medians were reported along with the medians.

Time frame: 12 weeks

Measure Improvement in the Median of the Mean OAB-Symptom Composite Score

OAB Symptom Composite Score (OAB-SCS) is a composite symptom score of toilet voids, urgency severity and urge urinary incontinence combining the Indevus Urgency Severity Scale (IUSS) for capture of urgency severity per toilet void with 24-hour frequency and UUI episodes. IUSS Score/void and/or UUI is assigned an OAB-SCS Point/Void: 0(none)=1, 1(mild/easily tolerated)=2, 2(moderate discomfort interfering with activities)=3, 3(severe/extreme urgency discomfort that abruptly stopped all activity or tasks)=4, UUI without void=5. Overall OAB-SCS Score is calculated for each day by multiplying the OAB-SCS Points/Void and/or UUIs by the number of events meeting criteria and adding the individual scores together. The minimum overall OAB-SCS score in a 24 hour period would be a 1 (representing a single mild void with a OAB -SCS Point/Void score of 0). The score would increase based upon the number voids/events and overall severity each event. Medians calculated for each treatment group.

Time frame: 12 weeks

Change in Median Total Health Related Quality of Life (HRQL) of OAB-q From Baseline (Screening) to Week 12

The OAB-q is validated to measure symptom bother and life impact due to OAB. It consists of an 8-item Bother Scale to assess individual symptoms and a 25-item HRQL scale that in turn consists of 4 subscales (coping-8 items, concern-7 items, sleep-5 items and social-5 items) to assess impact on life. Responses for each item in the Bother Scale range from 1 (bothered not at all by the symptom) to 6 (Bothered A Very Great Deal). Scores are then added generating an overall Bother Score (severity) ranging from 8 to 48. For HRQL, individual responses range between 1-None of the Time to a 6-All of the Time. Subscale scores range from 8-48 (coping) 7-42 (concern), 5-30 (sleep) and 5-30 (social). Subscale scores are then added to generate the HRQL ranging between 25-150. Raw HRQL scores are transformed for standardization purposes as follows: ((Highest Possible Score-Actual Raw Score)/Range of Scores)\*1 00 so that scores could range from 0 (All of the Time) to 100 (None of the Time).

Time frame: 12 Weeks (Randomized Phase) and 12 Months (Open Label).

Change in Patient Perception of Bladder Condition (PPBC) From Baseline (Screening Period) to Week 12 as Defined as an Improvement in Severity.

PPBC is a 6-point scale (from 'no problems at all' to 'many severe problems') describing the problem level of the bladder condition at that moment. Improvement is defined as a reduction in the number and/or severity of observed problems.

Time frame: 12 Weeks (Randomized Phase) and 12 Months (Open Label Phase)

Assessment of Treatment Benefit Scale (TBS)

TBS is a patient-reported outcome comprised of a 4-point scale of checkboxes to describe the change in condition during treatment (greatly improved to worsened). Improvement was defined as a change in the patient's assessment of overall condition to improved or greatly improved over the course of treatment. Analysis was based upon the number of patients who reported an improvement in condition.

Time frame: 12 Weeks

Assessment of Improvement as Measure by Overactive Bladder Satisfaction With Treatment Questionnaire (OAB-SAT)

Overall satisfaction with treatment was assessed (OAB-SAT-q) an 11 question list with multiple scaled checkboxes to allow the subject to rate the treatment with regard to satisfaction, bother from side effects, treatment endorsement, and convenience.

Time frame: 12 weeks

Change Clinical Global Impressions at 12 Weeks

CGI is an Investigator assessment, which rates the severity of illness at baseline on a scale of 1 (normal, not ill at all) to 7 (Amongst the most extremely ill patients), and then rates improvement at 12 weeks on a scale of 1 (very much improved) to 10 (very much worse). The analysis was based upon the number of patients that "much" and "very much" improved.

Time frame: 12 weeks (Randomized Phase) and 12 Months (Open Label Phase)