Antimuscarinics for neurogenic overactive bladder in multiple sclerosis: real-life data

Abstract

Background: Antimuscarinics (AMs) represent the mainstay of treatment for storage lower urinary tract symptoms (LUTS) but few data are available on their impact in multiple sclerosis (MS) patients. Objective: To assess effectiveness and tolerability of AMs in MS patients with neurogenic detrusor overactivity (NDO). Methods: Sixty consecutive outpatients, who started treatment with AMs at one centre, were recruited. The primary endpoint was change in Patient’s Perception of Intensity of Urgency Scale (PPIUS) at 6 months; secondary endpoints were post-void residual urine (PVR) and pads used daily. Incidence and severity of adverse events (AEs) were recorded. Results: Significant reduction ( p < 0.001) of mean PPIUS and pads use were detected, as well as a significant increase ( p < 0.001) of PVR (143 ± 42 ml). AEs, recorded in 53% of patients, were frequently multiple and caused suspension of AM in 10% of cases, mainly for xerostomia, which has been the commonest AE (26.6%). Neurological AEs appeared in 11.7% of subjects, mostly with oxybutynin. Worsening/onset of voiding LUTS, reported by 8.3% of MS, resulted to be the unique AE correlated to AM dosage. Conclusion: This study suggests that AMs are effective in MS patients, but their use should be tailored on every patient as even low dosages can be poorly tolerated. AEs, including neurological ones, are common.

Efficacy and Safety of Mirabegron Add-on Therapy After Failure With Solifenacin in Multiple Sclerosis Patients With Overactive Bladder: A Pilot Study

“…Both solifenacin 10 mg and oxybutynin immediate release 15 mg treatments resulted in an improvement of the urodynamic parameters and quality of life 16 . Another study has been conducted recently by Andretta et al, which resulted to a significant improvement in storage lower urinary tract symptoms in 73.3% of the cases, with a moderate risk of urinary retention as demonstrated by the average increase of PVR 17 . It is also stated that positive outcomes were obtained by dosage titration or combination of different AMA.…”

“…There are limited studies assessing tolerability of AMA among MS patients, yet the studies indicated low percentage of withdrawal because of intolerability. The side effects can sometimes be irrelevant with the dosage, yet in some occasions, dosage is increased to improve the efficacy and at that time side effects can occur 15–17 …”

“…16 Another study has been conducted recently by Andretta et al, which resulted to a significant improvement in storage lower urinary tract symptoms in 73.3% of the cases, with a moderate risk of urinary retention as demonstrated by the average increase of PVR. 17 It is also stated that positive outcomes were obtained by dosage titration or combination of different AMA. It is known that although AMA are mostly effective treating the symptoms, in some occasions, they might be ineffective or have intolerable side effects.…”

“…The side effects can sometimes be irrelevant with the dosage, yet in some occasions, dosage is increased to improve the efficacy and at that time side effects can occur. [15][16][17] Mirabegron is the first nonanticholinergic oral medication, which has been approved by Food and Drug administration (FDA) in 2012 for the treatment of OAB. It is a beta-3 adrenergic receptor agonist, which stimulates beta-3 receptors and causes muscle relaxation in the bladder.…”