Management of Overactive Bladder With OnabotulinumtoxinA: Systematic Review and Meta-analysis

Ramos, Hugo López; Castellanos, Lynda Torres; Esparza, Ingrid Ponce; Jaramillo, Alejandro; Rodríguez, Andrea; Bencardino, Camila Moreno

doi:10.1016/j.urology.2016.10.026

Cited by 23 publications

(22 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the present study, uncomplicated mild urinary tract infections and transient hematuria were seen in 5 (6.25%) patients each in the 2nd postoperative week. In another systematic review and meta‐analysis by Ramos et al, urinary retention was defined as a PVR over 200 mL and was higher in the 100 U onaBoNT‐A injection group than in the placebo group (relative risk: 11.49; 95%CI: 4.6‐28.70; P = 0.00001) . In the current study, CIC was initiated in three patients due to a higher PVR and was discontinued at the 2nd, 3rd, and 4th postoperative weeks.…”

Section: Discussionmentioning

confidence: 63%

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population

Önem

Bayrak

Demirtaş

et al. 2017

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims: To investigate the efficacy and safety of intradetrusor onabotulinumtoxinA (onaBoNT-A) injection in patients with overactive bladder (OAB) refractory to antimuscarinic treatment.Methods: A total of 80 patients with OAB symptoms were enrolled in this prospective multicenter study and received 100 U intradetrusor onaBoNT-A injection.The changes from baseline in the frequency of voiding, urge urinary incontinence (UI) and urge episodes, mean and maximum bladder capacities, uroflowmetry, post-void residual urine volume (PVR), quality of life score, and treatment benefit scale score were assessed. The need for a second injection,and treatment-related adverse events were also examined postoperatively.Results: OnaBoNT-A injection significantly decreased the UI episodes (P = 0.0001), the mean voiding frequency (P = 0.0001), and the urgency episodes (P = 0.0001) in the third month compared to baseline. Similarly, the mean bladder capacity, and maximal bladder capacity were increased (P < 0,05). The quality of life scores improved by 57.1% compared to the pretreatment rate (P = 0,0001). No significant change was observed in the PVR or maximum flow rate. Urinary retention developed in 3 (3.75%) patients and urinary infection and transient hematuria were observed in five patients (6.25%) each. The UI episodes, voiding frequency and urgency episodes were significantly lower at the 9th month than at baseline (all P = 0.0001).Overall 67% of the patients continued to experience benefits from the injection. Sixteen patients (20%) required a second injection in the third month. Eight patients were lost to follow-up at the last visit in the 9th month, and 34 of the remaining 56 patients required a second injection at the 9th month. Cumulatively, 50 (63%) patients needed re-injections. Conclusions:Our results demonstrated that the onaBoNT-A injection produced significant improvement in all OAB symptoms with a low incidence of treatment related adverse events.

show abstract

Section: Discussionmentioning

confidence: 63%

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population

Önem

Bayrak

Demirtaş

et al. 2017

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

“…This study also utilized robust data from two large randomized trials to develop models to predict outcomes after two different doses of BoNT‐A allowing prediction of outcomes after both 100 and 200 units. Thus far in multiple systematic reviews and meta‐analyses there has been insufficient evidence to determine an optimal starting dose for BoNT‐A 7,9,31–33 . It is possible that the increase risk of adverse events—elevated PVR and UTI—may modulate the effect of 200 units when compared to 100 units 34–36 .…”

Section: Discussionmentioning

confidence: 99%

“…Thus far in multiple systematic reviews and meta-analyses there has been insufficient evidence to determine an optimal starting dose for BoNT-A. 7,9,[31][32][33] It is possible that the increase risk of adverse events-elevated PVR and UTImay modulate the effect of 200 units when compared to 21 where apparent and bias-corrected curves are smoothed using loess. The bias-corrected curves are adjusted for optimism using bootstrapping with 1000 repetitions to correct for overfitting.…”

Section: T a B L E 2 Coefficients For The Prediction Modelsmentioning

confidence: 99%

Predicting outcomes after intradetrusor onabotulinumtoxina for non‐neurogenic urgency incontinence in women

Hendrickson

Xie

Rahn

et al. 2021

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims: Develop models to predict outcomes after intradetrusor injection of 100 or 200 units of onabotulinumtoxinA in women with non-neurogenic urgency urinary incontinence (UUI).Methods: Models were developed using 307 women from two randomized trials assessing efficacy of onabotulinumtoxinA for non-neurogenic UUI. Cox, linear and logistic regression models were fit using: (1) time to recurrence over 12 months, (2) change from baseline daily UUI episodes (UUIE) at 6 months, and (3) need for self-catheterization over 6 months. Model discrimination of Cox and logistic regression models was calculated using c-index. Mean absolute error determined accuracy of the linear model. Calibration was demonstrated using calibration curves. All models were internally validated using bootstrapping.Results: Median time to recurrence was 6 (interquartile range [IQR]: 2-12) months. Increasing age, 200 units of onabotulinumtoxinA, higher body mass index (BMI) and baseline UUIE were associated with decreased time to recurrence. The c-index was 0.63 (95% confidence interval [CI]: 0.59, 0.67). Median change in daily UUIE from baseline at 6 months was −3.5 (IQR: −5.0, −2.3). Increasing age, lower baseline UUIE, 200 units of onabotulinumtoxinA, higher BMI and IIQ-SF were associated with less improvement in UUIE. The mean absolute error predicting change in UUIE was accurate to 1.6 (95% CI:1.5, 1.7) UUI episodes. The overall rate of self-catheterization was 17.6% (95% CI: 13.6%-22.4%). Lower BMI, 200 units of onabotulinumtoxinA, increased baseline postvoid residual and maximum capacity were associated with higher risk of self-catheterization. The c-index was 0.66 (95% CI: 0.61, 0.76). The three calculators are available at http://riskcalc.duke.edu.

show abstract

“…Uncomplicated UTI was the most common adverse event; a 5.4% rate of urinary retention was observed 56 . A recent systematic review and meta‐analysis of randomised, placebo‐controlled studies supports the EMBARK findings 57 …”

Section: If Drug Therapy Fails What Is Next?mentioning

confidence: 73%

Shifting the treatment paradigm in idiopathic overactive bladder

et al. 2021

View full text Add to dashboard Cite

Summary Purpose Overactive Bladder (OAB) is a common condition that is known to have a significant impact on Health Related Quality of Life (HRQoL). Whilst all patients will initially benefit from lifestyle modifications and behavioural therapy in the first instance drug therapy remains integral in management pathways. The purpose of this review paper is to reappraise the evidence based approach to the management of OAB in addition to exploring a new treatment algorithm for the escalation of treatment in those patients with refractory symptoms. Design Literature Review Results Antimuscarinic drugs are currently the most commonly used medication although the introduction of mirabegron, a β3 agonist, has provided an alternative and also allowed combination therapy in those patients who have failed to improve on primary therapy or who have troublesome side effects. For those patients with symptoms of refractory OAB more invasive therapies including OnabotulinumtoxinA, sacral neuromodulation and Percutaneous Tibial Nerve Stimulation (PTNS) may be indicated. Conclusion We propose a new, evidence based, treatment algorithm for the management of OAB in patients who remain refractory to first line therapy.

show abstract

Management of Overactive Bladder With OnabotulinumtoxinA: Systematic Review and Meta-analysis

Cited by 23 publications

References 20 publications

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population

Predicting outcomes after intradetrusor onabotulinumtoxina for non‐neurogenic urgency incontinence in women

Shifting the treatment paradigm in idiopathic overactive bladder

Contact Info

Product

Resources

About