Comparative Effectiveness of Anticholinergic Therapy for OAB in Women

Abstract

for 54 subjects but achieved treatment of only 29 and was stopped early because of slow enrollment and unbalanced withdrawal after randomization (5 of the 17 in the LPTI group declined to proceed in the study after having been randomized). As a result, this study is significantly underpowered. Nonetheless, the findings are significant because women in both groups improved, albeit in different ways. Women receiving LPTI reported improved pain scores in fewer treatment sessions and sooner (an average of 4 weeks) than did women receiving PT. However, the improvement in pain scores with PT was overall similar, and notably women having PT had greater improvements in sexual function as measured by the FSFI, primarily because of greater improvements in sexual pain. These findings will be very useful in the design of a more definitive trial for treatment of this poorly understood condition. Ideally, a doubleblind randomized trial of LPTI versus PT could be designed using a sham intervention for PT and a sham saline LPTI injection as controls. Such a design would potentially also limit postrandomization withdrawals. We badly need these data in urogynecology practice, where numerous patients experience chronic PFM, many iatrogenically after prior surgical interventions, particularly those with permanent materials.-ACW) ABSTRACTBehavior and lifestyle modifications are considered first-line therapy for overactive bladder (OAB). When these approaches are inadequate, the mainstay of second-line therapy is pharmacologic. The largest class of medications used for drug treatment is anticholinergic. Emerging evidence in a systematic review published in 2011 suggested that anticholinergic and other drugs used for OAB are often ineffective for long-term symptom management, with most patients discontinuing therapy within 6 months. Despite questionable data supporting use of anticholinergics for OAB, wider use of these agents was spurred by the 2013 US Food and Drug Administration approval of oxybutynin (Oxytrol) as an over-the-counter treatment for this condition as well as extensive direct-to-consumer advertising. The issue of effectiveness of drug therapy is of major concern to millions of women with OAB and to their health care providers.The aims of this systematic review and meta-analysis were first to examine available evidence from randomized clinical trials on outcomes of pharmacologic management of OAB in women and second to summarize comparative data from the active drug and placebo arms of randomized trials on the effectiveness of drugs for reducing urinary incontinence episodes and reducing voiding episodes. A search of 4 databases was conducted by multiple reviewers for original research published in English up to March 2014 on community-dwelling women with nonneurogenic OAB undergoing therapy with medications available in the United States. The database search included MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and ClinicalTrials.gov. All studies were composed of at least 75% female subjec...