Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre placebo controlled randomised trial of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin).
Kidney stone disease is a common health problem affecting about 1.6 million adults in the UK. In some patients the stone will fall out of the kidney and become lodged in the tube (ureter) between the kidney and bladder. The majority of sufferers experience a sudden episode of prolonged abdominal pain, usually sufficiently severe to need emergency admission to hospital. Given the pain experienced passing a ureteric stone and the high cost of having to remove them, any simple treatment that hastens or increases the chance of spontaneous stone passage would be welcomed by both patients and the NHS.
The aim of this trial was to determine the clinical and cost-effectiveness of the use of alpha blockers (tamsulosin) and calcium channel blockers (nifedipine) in the management of symptomatic urinary stones. The primary clinical outcome of the trial (measured at four weeks) was the spontaneous passage of the stone as measured by the need for further intervention in the treatment of the stone. To reflect the multidimensional nature of the possible effects the intervention may have there was also a primary health economic outcome of incremental cost per quality adjusted life years (QALYs) gained at 12.
This multi-centre trial, funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, recruited 1200 participants over 24 months who were deemed suitable for conservative management (randomising 400 to each of the three treatment groups; alpha blockers, calcium channel blockers and placebo).
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Pickard, R., Starr, K., MacLennan, G., Kilonzo, M., Lam, T., Thomas, RE., 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. & 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, vol 19, no. 63.
[Online] DOI: 10.3310/hta19630
Pickard, R., Starr, K., MacLennan, G., Lam, T., Thomas, RE., Burr, J., McPherson, G., McDonald, A., Anson, K., N'Dow, JMO., Burgess, N., Clark, T., Kilonzo, M., Gillies, K., Shearer, K., Boachie, C., Cameron, S., Norrie, J. & McClinton, S. (2015). 'Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial'. The Lancet, vol 386, no. 9991, pp. 341-349.
[Online] DOI: 10.1016/S0140-6736(15)60933-3
[Online] AURA: 1_s2.0_S0140673615609333_main.pdf