Duloxetine in women awaiting surgery
Stress urinary incontinence (SUI) is a common condition affecting millions of women worldwide. It has a significant impact on the quality of life (psychosocial, social and economic well-being) of sufferers and their families. Until recently, treatment options for SUI were limited to conservative treatments such as pelvic floor muscle training, which usually has a poor compliance over time, or surgical procedures that carry the risk of complications and are mainly an option for more severely affected women. Duloxetine, a potent and relatively balanced serotonin and noradrenaline reuptake inhibitor, has been evaluated in phase II and phase III clinical trials and was found to be efficacious and safe in the treatment of women with moderate to severe SUI symptoms. Even in a subgroup of women with severe SUI awaiting surgery, with or without the presence of intrinsic sphincter deficiency, duloxetine was found to be effective. In addition, a good correlation was found between efficacy outcome measures and ratings of global impression scores. Women begin to perceive themselves as being better with treatment when their incontinence episodes frequency (IEF) decreases by 46% or their Incontinence Quality of Life (I-QOL) score improves by 6.3 points. The improvements in IEF and I-QOL obtained with duloxetine were well above these threshold levels, whereas these with placebo were not. All duloxetine responses were observed within 2 weeks. Overall, duloxetine is an effective treatment for a wide variety of women presenting with SUI symptoms. It has been approved in Europe for the treatment of women with moderate to severe SUI symptoms and is now available in many European countries.