Neurotoxin Treatments for Urinary Incontinence in Subjects With Spinal Cord Injury or Multiple Sclerosis: A Systematic Review of Effectiveness and Adverse Effects

Abstract

Background/Objective: The objective was to evaluate the effectiveness of neurotoxin treatments of urinary incontinence (UI) in individuals with spinal cord injury (SCI) or multiple sclerosis (MS). Methods: Studies were included if published in English, presented randomized adults with SCI or MS, and reported UI outcomes. Results: Ten trials randomizing 288 subjects with SCI (43%), MS (52%), or other spinal conditions (5%) and UI refractory to oral antimuscarinics were included. The overall mean age was 41 years, and 46% were women. Study durations ranged from 1 to 18 months. Treatments included botulinum toxin-A (BTX-A, 2 trials) and 2 vanilloid compounds, capsaicin (6 trials) and resiniferatoxin (4 trials). BTX-A was superior to placebo and resiniferatoxin in reducing daily UI episodes, mainly in individuals with SCI, although significant reductions vs placebo were not evident throughout the study duration. There were 1.1 fewer daily UI episodes in the BTX-A 200 unit group vs 0.1 fewer for the placebo group at the final week 24 assessment. Capsaicin was generally superior to placebo. The weighted difference between capsaicin and placebo in a pooled analysis of 2 trials enrolling subjects with either paraplegia or tetraplegia (n¼ 32) wasÀ3.8 daily UI episodes [95% CIÀ4.7 to À2.9] after 30 days. Capsaicin was comparable to resiniferatoxin. Pelvic pain and facial flushing were associated with capsaicin. Conclusion: Neurotoxins may improve refractive UI in adults with SCI or MS, although trial results were inconsistent. Trials were small in size and relatively short in duration. Further studies are needed to determine the efficacy and tolerability of long-term application.

The prevalence of urinary catheterization in women and men with multiple sclerosis

“…In the six years, since these data were acquired, intradetrusor onabotulinum A toxin injection for neurogenic detrusor overactivity has become more widely available and even more recently, Food and Drug Administration (FDA) approved (October 2011). 15 Furthermore, sacral neuromodulation has also become more widely utilized for the treatment of refractory OAB. At the time of the Fall 2005 questionnaire both treatments were relatively new and only sacral neuromodulation was FDA approved, while onabotulinum A toxin was off-label, partially accounting for the limited use of these therapies.…”

Neurogenic Bladder: Current Pharmacologic Trends

“…MacDonald et al [37] conducted a systematic review of the effectiveness and toxicity of intravesical neurotoxins on NGB patients. There were four randomized, placebocontrolled trials comparing capsaicin with placebo.…”

Past, Present and Future of Chemodenervation with Botulinum Toxin in the Treatment of Overactive Bladder

“…Peripherally acting drugs, such as resiniferatoxin (RTX) and onaBoNT-A are of clinical value. Intravesical capsaicin and RTX are vanilloids that selectively block afferent nerves, which are rarely used clinically due to difficulty in delivery, inconsistent efficacy, and acute pain 6 . OnaBoNT-A injected into the bladder wall blocks both afferent and efferent nerves 7–9 , and recent studies suggest that restricting the action to only afferent nerves may improve the safety profile of onabotulinumtoxin 10 .…”