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International Urogynecology Journal

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Open Access 01-10-2019 | Constipation | Review Article

Updating the evidence on drugs to treat overactive bladder: a systematic review

Authors: Frances C. Hsu, Chandler E. Weeks, Shelley S. Selph, Ian Blazina, Rebecca S. Holmes, Marian S. McDonagh

Published in: International Urogynecology Journal | Issue 10/2019

Abstract

Introduction

Overactive bladder (OAB) is a common condition, increasing with age and affecting quality of life. While numerous OAB drugs are available, persistence is low. We evaluated evidence published since 2012 to determine if newer drugs provided better efficacy and harm profiles.

Methods

We searched MEDLINE and the Cochrane Library from 2012 to September 2018 using terms for included drugs and requested information from manufacturers of included drugs. We performed dual review of all systematic review processes, evaluated study quality, and conducted meta-analyses using random effects models.

Results

In addition to 31 older studies, we included 20 trials published since 2012 (N = 16,478; 4 good, 11 fair, and 5 poor quality). Where statistical differences were found, they were clinically small (reductions of < 0.5 episodes/day). Solifenacin plus mirabegron improved efficacy outcomes over monotherapy with either drug, but significantly increased constipation compared with solifenacin and dry mouth compared with mirabegron. Solifenacin reduced incontinence over mirabegron and tolterodine and urgency episodes over tolterodine. Mirabegron did not differ from tolterodine in efficacy but had significantly lower incidence of dry mouth than solifenacin or tolterodine. Fesoterodine showed significant improvements but also anticholinergic effects vs. tolterodine. Oxybutynin, solifenacin, and tolterodine had similar efficacy, but dry mouth led to greater discontinuation with oxybutynin. Blurred vision, cardiac arrhythmia, and dizziness were uncommon.

Conclusion

New evidence confirms small, but clinically uncertain, differences among monotherapies and also between combination and monotherapy, regardless of statistical significance. While drugs mainly differed in incidence of dry mouth or constipation, none provided improved efficacy without increased harms.

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Title: Updating the evidence on drugs to treat overactive bladder: a systematic review
Authors: Frances C. Hsu
Chandler E. Weeks
Shelley S. Selph
Ian Blazina
Rebecca S. Holmes
Marian S. McDonagh
Publication date: 01-10-2019
Publisher: Springer International Publishing
Keywords: Constipation
Oxybutynin
Overactive Bladder
Trospium
Urinary Incontinence
Fesoterodine
Tolterodine
Constipation
Solifenacin
Urinary Incontinence
Darifenacin
Published in: International Urogynecology Journal / Issue 10/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04022-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Updating the evidence on drugs to treat overactive bladder: a systematic review

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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