Efficacy and tolerability of combined medication of two different antimuscarinics for treatment of adults with idiopathic overactive bladder in whom a single agent antimuscarinic therapy failed

Abstract

Objective: Recent studies have investigated a combination of two antimuscarinics for adult neurogenic bladder managed with clean intermittent catheterization or pediatric refractory overactive bladder (OAB). We assessed the efficacy and tolerability of this strategy in adults with idiopathic OAB. Methods: We reviewed 49 patients with idiopathic OAB who received combined antimuscarinic medication. Patients had serially received different kinds of antimuscarinics as monotherapy, but wished to take combined medication due to a lack of sufficient subjective improvement in urgency, even with dosage escalation. Efficacy was measured by changes of episodes of urgency, daytime voiding, nocturia and mean voided volume before and after the addition of the second antimuscarinic. Results: The mean duration of combined medication was 9.3 months. After adding the second antimuscarinic, urgency per day decreased from 3.8 to 1.9 (p < 0.001) and daytime voiding decreased from 10.4 to 7.4 (p < 0.001). The number of nocturia episodes and the mean voided volume also improved, although there was no statistical significance. Efficacy did not differ between the 29 cases, with non-selective and non-selective drugs and 20 cases with non-selective and M3 selective drugs. Thirty-three (67.3%) patients reported to have benefited from combined medication. Maximal flow rate and post-void residual volume did not change in either of the sexes. Eleven (22.4%) patients discontinued the combination due to continued ineffectiveness and dry mouth. Conclusion: This retrospective study suggests that combined medication can help adults with refractory idiopathic OAB. Combined medication was tolerated in most of our patients.

Combination therapy in overactive bladder‐untapped research opportunities: A systematic review of the literature

“…The three studies, which had cohorts of 177 to 313 individuals, demonstrate that compared to placebo, combinations of trospium and solifenacin result in decreases in urinary urgency and urge incontinence, though only one of the studies achieves statistical significance. Likewise, Yi et al found that in 49 patients, the combination therapy of propiverine or tolteridine with another anticholinergic medication improves urinary urgency and urge incontinence compared to baseline monotherapy in a statistically significant manner.…”

“…Four articles were identified that examined the use of anticholinergic medications in combination with each other (Table ) . Three of the four studies were conducted by Kosilov et al at the Institute of Physical Health in Russia.…”

“…Four articles were identified that examined the use of anticholinergic medications in combination with each other ( Table 3). [10][11][12][13] Three of the four studies were conducted by Kosilov et al at the Institute of Physical Health in Russia. The three studies, which had cohorts of 177 to 313 individuals, demonstrate that compared to placebo, combinations of trospium and solifenacin result in decreases in urinary urgency and urge incontinence, though only one of the studies achieves statistical significance.…”

Double anticholinergic therapy for refractory neurogenic and non-neurogenic detrusor overactivity in children: Long-term results of a prospective open-label study

“…Amend and colleagues also hypothesized that patients refractory to highdosage monotherapy might be fast metabolizers who would benefit from higher doses. 21 Finally, as suggested by other groups, 21,22 there could be a synergistic or additive effect of both drugs on the receptors. Considering that the pathophysiology of overactive bladder is not fully understood, there is clearly a need for more research to shed light on the exact mechanism of action.…”

Efficacy and Adherence of Flexibly Adding on a Second Antimuscarinic Agent for Patients with Refractory Overactive Bladder

“…Limited evidence has revealed that combined high‐dosed therapy is effective and safe for treating refractory neurogenic detrusor overactivity . Recently, Yi et al showed the efficacy and tolerability of two different antimuscarinics in adults with idiopathic OAB refractory to a single antimuscarinic agent . However, this retrospective study used at least 10 heterogeneous combined antimuscarinics.…”