The Effectiveness of Anticholinergic Therapy for Overactive Bladders: Systematic Review and Meta-Analysis

Fonseca, Adelaida Pallavicini; Meinberg, Mariana Furtado; Monteiro, Marilene Vale de Castro; Roque, Matheus; Haddad, JM; Castro, Rodrigo Aquino

doi:10.1055/s-0036-1594289

Cited by 5 publications

(4 citation statements)

References 63 publications

(41 reference statements)

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“…[9][10][11] Furthermore, anticholinergics have the potential to cause adverse events such as dry mouth, constipation, cognitive and functional impairment, risk of falls, and in some cases, all-cause death, which can be pronounced in certain patient subsets, particularly the elderly and those with specific medical conditions. [12][13][14][15][16] Despite the potential for nocturia to aggravate poor health outcomes, the economic burden of nocturia, including its direct and indirect costs to patients and payers, has not been well documented in the literature. This study sought to assess differences in health care resource utilization (HCRU), health care costs, and work productivity in adult patients with differing frequencies of nocturia episodes (i.e., < 2 vs. ≥ 2 nocturia episodes per night).…”

Section: Outcomes Assessmentsmentioning

confidence: 99%

Economic Burden of Illness in Adult Patients with Nocturia

Dmochowski

Brucker

Cole

et al. 2019

JMCP

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BACKGROUND: Nocturia is considered to be a very bothersome lower urinary tract disorder. Yet, to date, the economic burden attributable to this poor health condition remains less well known.OBJECTIVE: To compare differences in health care resource utilization (HCRU), health care costs, and work productivity in adult patients with differing frequencies of nocturia episodes (i.e., < 2 vs. ≥ 2 nocturia episodes per night).METHODS: Adult patients with nocturia enrolled in an integrated proprietary database were recruited to complete a survey on their demographics, nocturia characteristics, and work productivity. Using patients' survey data and health care claims from the previous 6 months, those with < 2 (n = 197; 21.9%) versus ≥ 2 (n = 702; 78.1%) nocturia episodes per night were compared for differences in HCRU, health care costs, and work productivity after adjusting for potential confounders. HCRU was reported as the mean number per patient per month (PPPM) for outpatient visits (all types), physician office visits, and prescriptions filled and the proportion of patients with ≥1 hospitalization or emergency department visit in the previous 6 months. Health care costs were reported as mean PPPM. Work productivity was assessed via patient survey and reported as a mean percentage for absenteeism, presenteeism, overall work impairment, and activity impairment during the past week. RESULTS: 899 adult patients (mean age = 71.4 years; 57.2% men) were enrolled and analyzed. Compared with patients with <2 nocturia episodes per night, patients with ≥ 2 nocturia episodes had more outpatient health care visits (unadjusted mean visits PPPM: 2.1 vs.

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Section: Outcomes Assessmentsmentioning

confidence: 99%

Economic Burden of Illness in Adult Patients with Nocturia

Dmochowski

Brucker

Cole

et al. 2019

JMCP

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“…The clinical presentations of overactive bladder (OAB) and CRBD are quite similar, and thus drugs useful in managing OAB could be used in the prevention of CRBD [2,3]. Antimuscarinic agents are the first choice of drugs for OAB [4]. Darifenacin and solifenacin have recently been studied for the prevention of CRDB with varying success rates [5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of trospium for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study

Srivastava

Agrawal

Deshmukh

et al. 2020

Korean J Anesthesiol

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Background: Catheter-related bladder discomfort (CRBD) is a frequent complaint after awakening from anesthesia in patients receiving perioperative bladder catheterization. Overactive bladder (OAB) and CRBD show similar symptoms; thus, drugs used for the management of OAB influence symptoms of CRBD. Trospium chloride has been found effective in managing resistant cases of OAB. We evaluated the efficacy of oral trospium on CRBD in the postoperative period. Methods: Sixty-four male and female adult patients, with planned spinal surgery and requiring urinary bladder catheterization, were randomly divided into two groups of 32 each. Group T patients received 60 mg extended-release oral trospium (extended-release) 1 h before induction of anesthesia and Group C patients received a similar-looking placebo. The anesthetic technique was identical in both groups. The CRBD score was evaluated in the postoperative ward using a 4-point scale (1 = no discomfort, 2 = mild, 3 = moderate, 4 = severe). Readings were recorded on arrival (0 h), and 1 h, 2 h, and 6 h postoperatively. All patients received fentanyl for postoperative pain relief. Results: The incidence of CRBD was significantly higher in Group C than in Group T at 0 h (66% vs. 22%, P = 0.001) and 1 h postoperatively (72% vs. 28%, P = 0.001). The incidence of moderate to severe CRBD was higher in Group C at postoperative 2 h (82% vs. 14%, P = 0.004). There was no significant difference in postoperative fentanyl requirements. Conclusions: Pretreatment with 60 mg extended release trospium reduced the incidence and severity of CRBD in the early postoperative period.

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“…Currently, antimuscarinic drugs are also the first-line medical therapy for OABS. Several clinical trials have confirmed the therapeutic efficacy of antimuscarinic agents in patients with OABS [5]. By contrast, anticholinergics have been reported to cause adverse effects in patients with OABS, such as dementia, dry mouth, astriction, and cognitive disorders [6].…”

Section: Introductionmentioning

confidence: 99%

Mirabegron Add-On Tamsulosin for Men with Overactive Bladder Symptoms: A Pooled Analysis of Four Randomized Controlled Trials

Wu,

Li,

Zhou

et al. 2024

Urol Int

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Introduction: Overactive bladder symptoms (OABS) affect patients’ quality of life (QOL) worldwide. This pooled analysis compared the efficacy and safety of mirabegron add-on tamsulosin with those of tamsulosin add-on placebo in OABS treatment. Methods: PubMed, Embase, MEDLINE, and the Cochrane Controlled Trial Register databases were searched for randomized controlled trials (RCTs) examining the efficacy of mirabegron add-on therapy to tamsulosin in the treatment of OABS. Moreover, references from the selected studies were screened. Review Manager 5.4 was used to analyze data. Results: Four RCTs involving 1397 patients with OABS were selected. Of the total, 697 patients receiving mirabegron add-on tamsulosin constituted the experimental group and 700 patients receiving tamsulosin add-on placebo constituted the control group. The efficacy endpoints were as follows: mean number of micturition per day (mean difference [MD] = −0.26, 95% confidence interval [CI] = −0.41 to −0.10, P = 0.0001), urgency episodes per day (MD = −0.67, 95% CI = −1.02 to −0.32, P = 0.0002), urgency urinary incontinence (UUI) episodes per day (MD = −0.42, 95% CI = −0.66 to −0.19, P = 0.0005), mean volume voided/micturition (MD = 10.84, 95% CI = 4.97 to 16.71, P = 0.0003), total International Prostate Symptom Score (IPSS) (MD = −2.01, 95% CI = −4.02 to −0.01, P = 0.05), and IPSS QOL index (MD = −0.65, 95% CI = −0.94 to −0.35, P < 0.0001). Mirabegron therapy add-on therapy to tamsulosin was effective in treating patients with OABS. Moreover, mirabegron might reduce the total IPSS (MD = −2.01, 95% CI = −4.02 to −0.01, P = 0.05). The safety endpoint, treatment-emergent adverse events (odds ratio = 0.94, 95% CI = 0.78 to 1.13, P = 0.49), suggested that although mirabegron was well-tolerated, it possibly increased the post-void residual urine volume (MD = 10.28, 95% CI = 1.82 to 18.75, P = 0.02). Conclusion: Combination therapy using mirabegron and tamsulosin may be effective in treating patients with non-neurogenic OABS in terms of UUI episodes, total IPSS, and IPSS QOL index. However, its effectiveness must be verified by analyzing additional factors for OABS through further RCTs.

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The Effectiveness of Anticholinergic Therapy for Overactive Bladders: Systematic Review and Meta-Analysis

Cited by 5 publications

References 63 publications

Economic Burden of Illness in Adult Patients with Nocturia

Economic Burden of Illness in Adult Patients with Nocturia

Efficacy of trospium for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study

Mirabegron Add-On Tamsulosin for Men with Overactive Bladder Symptoms: A Pooled Analysis of Four Randomized Controlled Trials

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