Choosing the Most Efficacious and Safe Oral Treatment for Idiopathic Overactive Bladder: A Systematic Review and Network Meta-analysis

Mostafaei, Hadi; Salehi‐Pourmehr, Hanieh; Jilch, S.; Carlin, Greta Lisa; Mori, Keiichiro; Quhal, Fahad; Pradère, Benjamin; Grossmann, Nico C.; Laukhtina, Ekaterina; Schuettfort, Victor M.; Aydh, Abdulmajeed; Motlagh, Reza Sari; König, Frederik; Roehrborn, Claus G.; Katayama, Satoshi; Rajwa, Paweł; Hajebrahimi, Sakineh; Shariat, Shahrokh F.

doi:10.1016/j.euf.2021.08.011

Cited by 17 publications

(17 citation statements)

References 79 publications

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“…[10][11][12]14 A network metaanalysis of 54 studies looking at 25 different drug formulations and doses, also found no significant differences in medical efficacy. 12 Recently concerns of cognitive impacts of anticholinergics have also distinguished beta-3 agonists from anticholinergics. 15,16 As evidence to elucidate the cognitive impact of bladder anticholinergic develops, the balance of equipoise in second-line therapy may shift to favor beta-3 adrenergic agonists, which have not been associated with this adverse effect.…”

Section: Equipoise In Second-line Therapymentioning

confidence: 99%

“…Again the main distinction between mirabegron and anticholinergics was tolerability 10–12,14 . A network meta‐analysis of 54 studies looking at 25 different drug formulations and doses, also found no significant differences in medical efficacy 12 . Recently concerns of cognitive impacts of anticholinergics have also distinguished beta‐3 agonists from anticholinergics 15,16 .…”

Section: Oab Care As a Preference Sensitive Conditionmentioning

confidence: 99%

“…Several meta-analyses have shown decreased frequency of micturition and urgency incontinence episodes with either class of medication. [9][10][11][12] Anticholinergics have been found to significantly decrease symptoms of OAB compared to placebo; however, all medications within this class are associated with side effects such as dry eyes, dry mouth, and constipation. 1,13 A meta-analysis reported that, compared to placebo, anticholinergics results in increased patient perception of cure though modest overall decrease in number of incontinence episodes.…”

Section: Equipoise In Second-line Therapymentioning

confidence: 99%

“…Pharmacotherapy with either anticholinergics or beta‐3 adrenergic receptor‐agonists (beta‐3 agonists) is second‐line therapy for OAB. Several meta‐analyses have shown decreased frequency of micturition and urgency incontinence episodes with either class of medication 9–12 . Anticholinergics have been found to significantly decrease symptoms of OAB compared to placebo; however, all medications within this class are associated with side effects such as dry eyes, dry mouth, and constipation 1,13 .…”

Section: Oab Care As a Preference Sensitive Conditionmentioning

confidence: 99%

“…A systematic review found that overall, the efficacy of mirabegron and vibegron on micturition frequency and on urgency urinary incontinence episodes and continence was superior to placebo and comparable to anticholinergics 11 . Again the main distinction between mirabegron and anticholinergics was tolerability 10–12,14 . A network meta‐analysis of 54 studies looking at 25 different drug formulations and doses, also found no significant differences in medical efficacy 12 .…”

Section: Oab Care As a Preference Sensitive Conditionmentioning

confidence: 99%

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Delivering patient‐centered care through shared decision making in overactive bladder

Paudel

Lane

2022

Neurourology and Urodynamics

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Introduction Men and women living with overactive bladder (OAB) face many treatment decisions as they progress through the treatment pathway. Decisions to pursue specific therapies are highly preference sensitive and ideal for shared decision making (SDM). The aim of this narrative review is to provide urologists with a practical summary of methods to elicit preferences and facilitate SDM to promote patient‐centered care for OAB. Methods We explore OAB as a preference sensitive condition through a review of treatment outcomes and present available data on prediction tools, patient preferences, and decision aids. We propose a paradigm for applying Everyday SDM to OAB care. Results Clinical outcome data points to equipoise (balanced outcomes) between options for first‐, second‐, and third‐line OAB therapies, making OAB preference sensitive and appropriate for SDM. Methods to personalize care through individualized outcome prediction calculators and tools to elicit patient preferences are emerging. While patient information about OAB is readily available, we identified few OAB decision aids that facilitate patient preference elicitation and SDM. Conclusions OAB is a preference sensitive condition, where treatment is largely based on the patient's preferences and values. SDM is an ideal approach to supporting patients through these treatment decisions. We propose the application of Everyday SDM, a personalized, clinically efficient methodology as a method to support patient‐centered OAB care.

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Section: Equipoise In Second-line Therapymentioning

confidence: 99%

Section: Oab Care As a Preference Sensitive Conditionmentioning

confidence: 99%

Section: Equipoise In Second-line Therapymentioning

confidence: 99%

Section: Oab Care As a Preference Sensitive Conditionmentioning

confidence: 99%

Section: Oab Care As a Preference Sensitive Conditionmentioning

confidence: 99%

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Delivering patient‐centered care through shared decision making in overactive bladder

Paudel

Lane

2022

Neurourology and Urodynamics

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Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study

Laukhtina

Boehm

Peyronnet³

et al. 2022

World J Urol

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Introduction The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB). Materials and methods We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement). Results A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04). Conclusion In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients’ history may allow for better clinical decision-making and patient counseling.

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Impact of sex on outcomes after surgery for non-muscle-invasive and muscle-invasive bladder urothelial carcinoma: a systematic review and meta-analysis

Mori

Yanagisawa²,

Katayama³

et al. 2022

World J Urol

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Purpose To assess the prognostic value of sex for non-muscle-invasive/muscle-invasive bladder urothelial carcinoma (NMIBC/MIBC) treated with radical surgery. Methods The PubMed, Web of Science, and Scopus databases were searched in November 2021 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they involved the comparison of the overall, cancer-specific, progression, and recurrence-free survival of patients with NMIBC/MIBC. Formal sex-stratified meta-analyses of these outcomes were performed. Results Thirty-one studies, which included 32,525 patients with NMIBC, and 63 studies, which included 85,132 patients with MIBC, were eligible for review and meta-analysis. Female sex was associated with worse cancer-specific survival (pooled hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.11–1.31) and overall survival (pooled HR, 1.02; 95% CI, 1.00–1.05) in patients with MIBC. In contrast, however, sex was not associated with cancer-specific survival (pooled HR, 1.01; 95% CI, 0.70–1.46), progression-free survival (pooled HR, 1.04; 95% CI, 0.88–1.24), and recurrence-free survival (pooled HR, 1.06; 95% CI, 0.98–1.16) in patients with NMIBC. Conclusions Sex is associated with an increased risk of worse survival outcomes in patients with MIBC but not in those with NMIBC. Given the genetic and social differences between sexes, sex may represent a key factor in the clinical decision-making process.

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Choosing the Most Efficacious and Safe Oral Treatment for Idiopathic Overactive Bladder: A Systematic Review and Network Meta-analysis

Cited by 17 publications

References 79 publications

Delivering patient‐centered care through shared decision making in overactive bladder

Delivering patient‐centered care through shared decision making in overactive bladder

Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study

Impact of sex on outcomes after surgery for non-muscle-invasive and muscle-invasive bladder urothelial carcinoma: a systematic review and meta-analysis

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