SUSPEND

SUSPEND:  Spontaneous Urinary Stone Passage ENabled by Drugs, use of drug therapy in the management of symptomatic stones in hospitalised adults: a multicentre, placebo-controlled randomised trial of calcium channel blockers (nifedipine) and alpha blockers (tamsulosin)

One in eight adults are affected by urinary stones with 50% having a recurrence within five years resulting in significant calls on health service resources. Two recent meta-analyses have reported a potential role for alpha blockers and calcium channel blockers in facilitating ureteric stone passage. However, the quality of included trials was poor and there was insufficient evidence that they were cost-effective. The three-group, placebo-controlled, randomised trial compared the use of an alpha blocker (tamsulosin), a calcium channel blocker (nifedipine) and placebo. All three tablets looked identical. Primary outcome was passage of stone. The hypothesis being tested was that use of either nifedipine or tamsulosin would result in an absolute increase in the stone-free rate of 15% relative to placebo and that there was an absolute difference of 10% in stone-free rate between calcium channel blockers (nifedipine) and alpha blockers (tamsulosin).

Outcome and Translation

The trial found that tamsulosin and nifedipine did not increase the likelihood of stone passage over four weeks for people with ureteric colic, and, therefore, use of these drugs is very unlikely to be cost-effective for the NHS.

HERU researchers involved in this research project: Mary Kilonzo

External collaborators: S McClinton, J N’Dow, G MacLennan, K Schumm, R Thomas (University of Aberdeen) and J Burr (St. Andrews University)

SUSPEND - Spontaneous Urinary Stone Passage ENabled by DrugsClick here for further details on this project

 

Publications

McClinton, S., Starr, K., Thomas, R., McLennan, G., McPherson, G., McDonald, A., Lam, T., NDow, J., Kilonzo, M., Pickard, R., Anson, K. and Burr, J. (2014) 'Use of drug therapy in the management of symptomatic ureteric stones in hospitalized adults (SUSPEND), a multicentre, placebo-controlled, randomized trial of a calcium-channel blocker (nifedipine) and an alpha-blocker (tamsulosin): study protocol for a randomized controlled trial [protocol]', Trials, 15(1), 238.

Pickard, R., Starr, K., MacLennan, G., Kilonzo, M., Lam, T., Thomas, R., Burr, J., McClinton, S. and and the SUSPEND Trial Group (2014) Group use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre placebo controlled trial of a calcium channel blocker (nifedipine) and an α-blocker (tamsulosin). The SUSPEND Trial final report., Aberdeen: University of Aberdeen HTA Group.

Pickard, R., Starr, K., MacLennan, G., Lam, T., Thomas, R., Burr, J., McPherson, G., McDonald, A., Anson, K., N'Dow, J., Burgess, N., Clark, T., Kilonzo, M., Gillies, K., Shearer, K., Boachie, C., Cameron, S., Norrie, J. and McClinton, S. (2015) 'Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial', The Lancet, 386(9991), 341-349.

Pickard, R., Starr, K., MacLennan, G., Kilonzo, M., Lam, T., Thomas, R., Burr, J., Norrie, J., McPherson, G., McDonald, A., Shearer, K., Gillies, K., Anson, K., Boachie, C., N'Dow, J., Burgess, N., Clark, T., Cameron, S. and McClinton, S. (2015) 'Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial)', Health Technology Assessment, 19(63).