Beta-Agonist Versus OnabotulinumtoxinA Trial for Urgency Urinary Incontinence

NCT ID: NCT05806164

Last Updated: 2025-09-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

432 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-06-06

Study Completion Date

2030-08-01

Brief Summary

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The goal of this clinical trial is to compare treatment outcomes between an oral medication (beta agonist) versus onabotulinumtoxinA injections in women with urgency urinary incontinence (UUI).

Participants will be randomly selected to receive one of the two treatments. The primary outcome measure will be at 3 months, and women will be followed for a total of 12 months.

Based on patient expert input, there are 2 primary outcomes: Treatment satisfaction and urinary symptom severity.

The study will also have a long-term follow-up component (prospective cohort) including 346 participants from the parent trial to describe treatment continuation, treatment efficacy, patient direct costs and other secondary outcomes up to 5 years after treatment.

Detailed Description

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The purpose of this study is to directly compare 2 primary outcomes (Treatment satisfaction and urinary symptom severity) between beta agonist oral medication versus onabotulinumtoxinA intradetrusor bladder injection for the treatment of UUI.

The study will also compare secondary outcomes identified as important by patients. At the end of the study, the investigators will have patient and stakeholder-derived comparative outcomes between these 2 commonly available treatment categories. A stakeholder and community engagement (CE) plan will be developed and implemented. The investigators will also develop a model to help guide patients and providers through this decision process.

SPECIFIC AIMS Specific Aim 1: Compare the efficacy of beta agonist versus onabotulinumtoxinA on patient-important treatment outcomes at 3 months in women with UUI.

This multi-center, randomized clinical trial (RCT) includes 5 sites across the U.S. Two co-primary outcomes will be measured using validated patient-reported outcomes (PROs), selected by patients: Co-primary outcome 1: Symptom severity, measured by change in Overactive Bladder Questionnaire-Symptom Bother Scale (OAB-q-SS) score.

Co-primary outcome 2: Treatment satisfaction, measured by the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General (FACIT-TS-G), powered based on a single item.

Specific Aim 2: Compare secondary patient-important outcomes. Direct comparisons between intervention effects on secondary outcomes chosen by patients and stakeholders, including adverse events, UUI quality of life, global improvement, and sexual function.

Specific Aim 3: Use predictive modeling to help stakeholders better determine expected outcomes after treatment with beta agonist versus onabotulinumtoxinA.

Comparators: Beta agonist oral medication (mirabegron or vibegron) versus intradetrusor onabotulinumtoxinA.

Both beta-agonists and onabotulinumtoxinA are US Food and Drug Administration (FDA) approved for the treatment of UUI, and widely available options with established efficacy.

432 women will be randomly assigned to each treatment option: 216 to beta agonist oral medication and 216 to intradetrusor onabotulintoxinA. Women will be undergo outcomes assessments at 3, 6, 9, and 12 months. The primary outcome measure will be at 3 months.

For the long-term follow up study, a prospective cohort of 346 study participants of the parent trial who agree will be followed with additional outcome assessments for 3-5 years. Outcomes for the long-term follow up study will include: continuation/discontinuation of treatment, treatment satisfaction and symptom control, treatment crossover, additional treatments, patient-important complications, costs, and understanding barriers to continued long-term UUI care and possible solutions. Qualitative methods will be expanded to further explore barriers to continuing long-term UUI care.

Conditions

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Urgency Urinary Incontinence

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

At 3 months, the effect of treatment with beta agonist oral medication or onabotulinumtoxinA will be evaluated within a classic RCT model. The analysis will determine the effect of treatment on the co-primary outcomes: Treatment satisfaction and urinary symptom severity.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Due to the nature of the interventions, masking of patients will not be possible; however, outcome assessors will be masked. Masked staff will not be able to see certain forms that may result in unmasking. All PROs will be administered prior to any clinical assessments to minimize bias that may occur due to clinical evaluation.

Study Groups

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Beta-3 receptor agonist oral medication

Selective beta-3 receptor agonist oral medication approved for the treatment of urgency urinary incontinence including mirabegron or vibegron. Usual clinical care standards will be used for prescribing and dosing changes. For mirabegron, dosages are 25 mg and 50 mg as clinically indicated. For vibegron, dosage is 75 mg daily by mouth as clinically indicated.

Group Type ACTIVE_COMPARATOR

Beta3-Agonists, Adrenergic [Mirabegron/Vibegron]

Intervention Type DRUG

The beta-agonist oral medication will be prescribed and dose adjusted per usual care.

Intradetrusor onabotulinumtoxinA

OnabotulinumtoxinA at a dose of 100 units will be injected into the bladder per usual care pathways.

Group Type ACTIVE_COMPARATOR

OnabotulinumtoxinA 100 UNT [Botox]

Intervention Type DRUG

OnabotulinumtoxinA will be prepared by dissolving 100 units into 10 ml of injectable saline. The injection will be an office based procedure, performed per usual care.

Interventions

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Beta3-Agonists, Adrenergic [Mirabegron/Vibegron]

The beta-agonist oral medication will be prescribed and dose adjusted per usual care.

Intervention Type DRUG

OnabotulinumtoxinA 100 UNT [Botox]

OnabotulinumtoxinA will be prepared by dissolving 100 units into 10 ml of injectable saline. The injection will be an office based procedure, performed per usual care.

Intervention Type DRUG

Other Intervention Names

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Botox

Eligibility Criteria

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Inclusion Criteria

1. 18 years or older
2. report at least "quite a bit bothered" or worse by their UUI defined by response to OAB-q-SS item #8 "How bothered are you by urine loss associated with a strong desire to urinate?"
3. are not and do not plan to become pregnant
4. have persistent UUI defined as previous unsuccessful results after conservative and anticholinergic treatment, or are unable to tolerate or have contraindications to anticholinergics
5. are currently not taking anticholinergics or are willing to stop medication for 3 weeks prior to enrollment.
6. for participants reporting mixed urinary incontinence symptoms, participant must (a) have less bother from SUI than from UUI, defined as a response of "Not at all bothered" or only "a little bit bothered" by SUI on the Urogenital Distress Inventory item "Do you experience urine leakage related to physical activity? (walking, running, laughing, sneezing, coughing), and (b) SUI symptoms be stable (\> 3 months), and (c)participant does not desire additional treatment for SUI in the upcoming 3 months.
7. Participants after unsuccessful neuromodulation trial can be eligible after a 4-week washout period.

Exclusion Criteria

1. clinical contraindication to beta-3 agonist or onabotulinumtoxinA
2. prior therapeutic trial of either study treatment
3. unevaluated hematuria, current or prior bladder malignancy
4. surgically altered detrusor muscle
5. prior pelvic radiation
6. post-void residual \>150 mL in past 3 months
7. neurogenic bladder
8. pelvic floor surgery within the past 3 months
9. anticipating pelvic surgery within primary outcome follow up period (3 months)
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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University of New Mexico

OTHER

Sponsor Role collaborator

University of Alabama at Birmingham

OTHER

Sponsor Role collaborator

University of California, San Diego

OTHER

Sponsor Role collaborator

Howard University

OTHER

Sponsor Role collaborator

Brown University

OTHER

Sponsor Role collaborator

Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

Women and Infants Hospital of Rhode Island

OTHER

Sponsor Role lead

Responsible Party

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Vivian Sung

MD, MPH, Professor of Obstetrics & Gynecology, The Warren Alpert Medical School of Brown University; Director of Research, Division of Urogynecology, Women & Infants Hospital of Rhode Island

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Vivian Sung, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Women and Infants Hospital of Rhode Island

Peter Jeppson, MD

Role: PRINCIPAL_INVESTIGATOR

University of New Mexico

Locations

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University of Alabama at Birmingham

Birmingham, Alabama, United States

Site Status RECRUITING

University of California, San Diego

San Diego, California, United States

Site Status RECRUITING

Howard University

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

Site Status RECRUITING

University of New Mexico

Albuquerque, New Mexico, United States

Site Status RECRUITING

Women & Infants Hospital of Rhode Island

Providence, Rhode Island, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Ann Meers, BS, RN

Role: CONTACT

401-274-1100 ext. 48228

Sara Veera, BS

Role: CONTACT

401-274-1100 ext. 48222

Facility Contacts

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Sunita Patel

Role: primary

205-996-0241

Gabriella Halder, MD

Role: backup

Kyle Herrala

Role: primary

858-657-6827

Angela Silva

Role: primary

Karen Taylor

Role: primary

505-205-4118

Cassandra Darley

Role: backup

Madeline Malloy, BS, RN

Role: primary

401-274-1100 ext. 48228

Sara Veera, BS

Role: backup

401-274-1100 ext. 48222

Other Identifiers

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1895985

Identifier Type: -

Identifier Source: org_study_id

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