OnabotulinumtoxinA for neurogenic detrusor overactivity and dose differences: a systematic review

Abstract

Purpose To evaluate the efficacy and safety of onabotulinumtoxinA for patients with neurogenic detrusor overactivity (NDO).Materials and Methods We searched the Cochrane Library, PUBMED, EMBASE, Chinese Bio-medicine database, China Journal Full-text Database, VIP database, Wanfang database for randomized controlled trials (from inception to September 2012). Two authors independently selected studies, extracted data and assessed the methodological and evidence quality using the Cochrane Risk of Bias Table and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) respectively. Data analysis was performed by RevMan 5.1 and descriptive analysis was employed if necessary.Results Eight studies were selected (n=1879 participants). OnabotulinumtoxinA was more related to urinary tract infection (UTI) (200U: OR 1.72, CI: 1.18-2.52; 300U: OR 1.88, CI: 1.31-2.69) versus placebo. Also, OnabotulinumtoxinA was superior to placebo in improving maximum cystometric capacity (MCC) (200U: OR 138.80, CI: 112.45-165.15; 300U: OR 152.09, CI: 125.25-178.93) and decreasing maximum detrusor pressure (MDP) (200U: MD -29.61, CI: -36.52--22.69; 300U: MD-28.92, CI: -39.59--18.25). However, there were no statistical differences between 200U and 300U onabotulinumtoxinA in UTI (OR 0.84, CI: 0.58-1.22), MCC (OR-12.72, CI: -43.36-17.92) and MDP (MD 2.21, CI: -6.80-11.22).Conclusions OnabotulinumtoxinA may provide superior clinical and urodynamic benefit for populations with NDO. High-quality studies are required for evaluating the optimal dose, long-term application and when to perform repeated injections.

Meta-Analysis of Randomized Controlled Trials Using Botulinum Toxin A at Different Dosages for Urinary Incontinence in Patients With Overactive Bladder

“…Nevertheless, the anticholinergic medicine is increasingly inappropriate for long-term therapy of NDO and IOAB, which is reflected in the unsatisfied effect and potential complications such as vesicoureteral reflux and even renal failure (Majumdar, 2004;Asimakopoulos et al, 2012), and also the high socioeconomic cost is considerable. Therefore, metaanalyses (Cui et al, 2013;Mehta et al, 2013;Cui et al, 2015;Sun et al, 2015;Zhang et al, 2015;Zhou et al, 2015;Cheng et al, 2016;Gu et al, 2017) evaluating the therapeutic effect of botulinum toxin A (BTX-A) on UI in OAB patients have increased as well as the relevant RCTs in recent years, in which the BTX-A demonstrated a satisfied clinical benefit. (Flynn et al, 2004;Kessler et al, 2005;Kuo, 2005;Popat et al, 2005;Rajkumar et al, 2005;Schulte-Baukloh et al, 2005;Schmid et al, 2006) Furthermore, the BTX-A is recommended for management of UI in OAB patient by the American Urological Association (AUA) guidelines (Gormley et al, 2015), and the other interventions consist of education and behavior therapies.…”

A systematic review and meta-analysis of effectiveness and safety of therapy for overactive bladder using botulinum toxin A at different dosages

“…Several relevant meta-analyses [ 15 – 21 ] had been conducted for NDO. In these meta-analyses, some studies compared different dosages of BTX-A with placebo at only one time point after BTX-A injection [ 15 , 20 , 21 ], while others compared pooled dosages with placebo [ 16 , 17 ]; however, there was a lack of comprehensive analysis and consideration of the influence of the dosages on effectiveness outcomes. One meta-analysis [ 19 ] compared the grouped data of the same outcome indicators at different time points, which could produce errors and interfere with correct conclusions, thus reducing the reliability and value of the study.…”

Efficacy and Adverse Events Associated With Use of OnabotulinumtoxinA for Treatment of Neurogenic Detrusor Overactivity: A Meta-Analysis

“…However, the optimal dose and adverse events associated with such treatment are controversial. Although Zhou et al [10] and Zhang et al [11] have compared the efficacy and adverse events of onabotulinumtoxinA treatment, Zhou et al included only 4 publications and was not able to analyze the dose of 500 U. Patients with NDO often have severe symptoms, which means a high dose of injected onabotulinumtoxinA is warranted.…”