Neurogenic bladder treatment by doubling the recommended antimuscarinic dosage

Horstmann, Marcus; Schaefer, T.; Aguilar, Yannick; Stenzl, Arnulf; Sievert, Karl Dietrich

doi:10.1002/nau.20289

Cited by 87 publications

(53 citation statements)

References 11 publications

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“…The first assumption is the additive effect of regular dosages of two antimuscarinics. 11,12 However, it seems unreasonable to simply connect our results with a dose-dependent effect because our results demonstrated the enhanced efficacy of combined medication in patients who did not respond to double-dosing monotherapy. Second, different receptor selectivity of two antimuscarinics might be considered.…”

Section: Drug Combinations Nmentioning

confidence: 82%

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

Jeong

Chung

et al. 2013

CUAJ

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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.

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Section: Drug Combinations Nmentioning

confidence: 82%

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

Jeong

Chung

et al. 2013

CUAJ

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“…This can be explained by the fact that neurogenic bladders are often more refractory to medical therapies, as pointed out by Horstmann and colleagues. 22 A 94% success rate in the non-neurogenic group is therefore reassuring since other treatments, such as intravesical oxybutynin, sacral neuromodulation or botulinum toxin (with their inherent 5% to 11% risk of clean intermittent catheterization), 23,24 would be deferred. For non-responders or children responding only partially to therapy, initial urodynamics were less favourable (stronger uninhibited detrusor contractions and smaller bladder capacity).…”

Section: Discussionmentioning

confidence: 99%

Long-term use of solifenacin in pediatric patients with overactive bladder: Extension of a prospective open-label study

Nadeau

Schröeder

Moore

et al. 2014

CUAJ

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Introduction: We evaluate the efficacy and safety of solifenacin to treat incontinence in children with non-neurogenic (DO) or neurogenic detrusor overactivity (NDO) refractory to oxybutinin or tolterodine. Methods: We updated and extended our previously published nonrandomized uncontrolled study on open-label use of adjusted-dose regimens of solifenacin (1.25-10 mg) in children with refractory incontinence. The follow-up included voiding diaries, post-void residuals, urine cultures, ultrasounds and urodynamic studies. Clinical data were updated as of September 2012. Subjective improvement was assessed with the Patient Perception of Bladder Condition (PPBC) scale. The primary end point was efficacy toward continence and secondary end points were tolerability and safety. Results: Overall, 244 patients (112 girls, 132 boys) were enrolled; 53 with NDO and 191 with DO. Minimal follow-up was 5 months, the mean duration of treatment was 21.0 months and the mean age at initiation was 9.2 years. Urodynamic capacity improved from 145 ± 76 mL to 339 ± 152 mL and the amplitude of uninhibited contractions decreased from 66 ± 26 to 20 ± 20 cmH 2 O (p < 0.0001). The overall success rate is 91%, and more specifically 94% for non-neurogenic and 79% for neurogenic, which is significantly different (p = 0.013). Twenty-three patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 175 patients, mild by 46, moderate by 9, and 14 withdrew due to their side effects. Ten patients developed post-void residuals of ≥20 mL. Conclusion: Although higher in the non-neurogenic group, high subjective and objective success rates were maintained over a longer follow-up with an adjusted-dose regimen of solifenacin to treat pediatric NDO or DO refractory to oxybutynin or tolterodine. Moreover, we found acceptable tolerability and safety profiles.

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“…22 Doubling the recommended AM dosage in patients nonresponsive to recommended doses improved urodynamic parameters significantly. 26 Moreover, the same authors showed that 85% of patients nonresponsive to dosage-escalated monotherapy could be treated successfully by combined high-dose AM. 27 Various studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Six studies investigated, whether flexible dosing improved therapeutic response (Table 1d), two with oxybutynin ER, 22,23 one with trospium chloride IR, 24 one with solifenacin, 25 one compared oxybutynin IR with tolterodine IR, 16 another tolterodine ER with trospium chloride IR. 26 Two studies combined high-dose AM in patients nonresponsive to dosage-escalated monotherapy. 27,28 Various studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

Neurogenic detrusor overactivity in adults: a review on efficacy, tolerability and safety of oral antimuscarinics

Madersbacher

Mürtz²,

Stöhrer

2013

Spinal Cord

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Objectives: This review analyzed efficacy, tolerability and safety of oral antimuscarinic (AM) drugs in adults suffering from neurogenic detrusor overactivity (NDO). Methods: A comprehensive search of major literature bases was conducted to identify all references. Results: Thirty studies, thereof 16 randomized controlled trials (RCT), enrolling 1479 patients were identified and included in the review. Results were grouped in dose-finding, placebo-and active-controlled, flexible dose and combined high-dose AM drugs, and various studies. Key urodynamic outcome parameters, such as maximum detrusor pressure and maximum cystometric bladder capacity, demonstrated the efficacy of AM in NDO, following 2-3 weeks of treatment. Contrary to idiopathic detrusor overactivity (IDO), no placebo effects manifested. Other important parameters, such as impact on the upper urinary tract function and morphology, issues of continence, post-void residual urine, catheterisation, urinary tract infections and quality of life, were investigated to a limited extent only. Incidence rates of adverse events were comparable for NDO and IDO. Most of the studies, especially RCT, were undertaken with oxybutynin immediate release (IR), trospium chloride IR, propiverine IR and propiverine extended release. In NDO, these drugs are best investigated. Conclusions: AM drugs are effective in NDO, they normalize the intravesical pressure and increase cystometric bladder capacity. However, other important parameters are not adequately investigated so far and should be recognized in future studies.

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Neurogenic bladder treatment by doubling the recommended antimuscarinic dosage

Abstract: The increased dosage of Tolterodine or Trospium is an effective treatment in patients with neurogenic bladder.

Cited by 87 publications

References 11 publications

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

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

Long-term use of solifenacin in pediatric patients with overactive bladder: Extension of a prospective open-label study

Neurogenic detrusor overactivity in adults: a review on efficacy, tolerability and safety of oral antimuscarinics

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