Patient factors associated with onabotulinum toxin A treatment outcome in women with detrusor overactivity

Owen, Rhiannon K; Abrams, Keith R.; Mayne, Christopher; Slack, Mark; Tincello, Douglas G.

doi:10.1002/nau.22948

Cited by 10 publications

(13 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For BoNTA, we found only one study that evaluated BMI as a predictive factor for treatment outcome. Owen et al evaluated patient factors associated with treatment outcome in a cohort of women with idiopathic detrusor overactivity. They found that besides smoking, higher BMI was associated with an increased risk of treatment failure.…”

Section: Treatment Of Oab and Uui—does Obesity Affect Outcome?mentioning

confidence: 99%

Exploring the relation between obesity and urinary incontinence: Pathophysiology, clinical implications, and the effect of weight reduction, ICI‐RS 2018

Marcelissen

Anding

Averbeck

et al. 2019

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims: To evaluate the relationship between obesity and urinary incontinence (UI) and to determine the effect of weight reduction on the severity of incontinence. (Bristol, UK): "What are the relationships between obesity and UI, and the effects of successful bariatric surgery?"Results: Obesity is an increasing problem worldwide and is associated with many adverse effects on health and quality of life. From both translational and clinical studies, there is a strong relationship between obesity and the occurrence of UI.Both mechanical and metabolic factors seem to play an important role including systemic inflammation and oxidative stress due to the release of cytokines in visceral adipose tissue. The success rate of anti-incontinence surgery does not seem to be greatly affected by body mass index (BMI), although reliable data and longterm follow-up are currently lacking. Both weight reduction programs and bariatric surgery can result in amelioration of UI. Various studies have shown that weight loss (particularly that associated with bariatric surgery) can reduce incontinence, and the degree of weight loss is positively correlated with improvement in symptoms. Conclusions: Obesity is strongly associated with an increased prevalence of both stress and urgency UI. The treatment outcome does not seem to be highly dependent on BMI. Weight reduction is positively correlated with improvement of incontinence symptoms and therefore should be advocated in the management. K E Y W O R D Sbariatric surgery, obesity, overweight, urinary incontinence 1 | INTRODUCTION Obesity has become a major global health challenge and the worldwide prevalence of obesity has nearly tripled between 1975 and 2016. According to the latest report of the World Health Organization more than 1.9 billion adults (39% of men and 40% of women) were overweight (body mass index [BMI], ≥25 kg/m 2 ) in 2016 and over

show abstract

Section: Treatment Of Oab and Uui—does Obesity Affect Outcome?mentioning

confidence: 99%

Exploring the relation between obesity and urinary incontinence: Pathophysiology, clinical implications, and the effect of weight reduction, ICI‐RS 2018

Marcelissen

Anding

Averbeck

et al. 2019

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

“…It might be suggested that the predictors of success identified by our study may vary depending on treatment dose, but it has recently been emphasized that there is no physiological or pharmacological reason why such a difference would exist. 51 In patients who did not respond to the treatment, other potential underlying disorders for the symptoms reported should be taken into account. It is noteworthy that patients with OAB symptoms may in fact suffer from painful bladder or interstitial cystitis; these individuals appear to respond less favorably to with onabotulinumtoxinA, 70 and if the treatment is effective, it has a shorter duration of action.…”

Section: Discussionmentioning

confidence: 99%

“…37 In OAB patients, smoking status has been found to be a predictive factor for non-response in urgency episodes (with smokers having nearly 3 times greater odds of nonresponse compared to non-smokers), and higher numbers of baseline leakage episodes are correlated with failure to achieve continence (for every additional increase in the number of baseline leakage episodes, patients had a 17% increase in the odds of failing to achieve continence; LE 1, GR B). 51 Body mass index (BMI) has been shown to have marginal associations with non-response to the treatment. It is worth noting that the risk factors identified in the study were derived from OAB women treated with 200 U of onabotulinumtoxinA and urodynamically proven detrusor overactivity.…”

Section: Other Factorsmentioning

confidence: 99%

See 1 more Smart Citation

How to assess and predict success or failure of intra-detrusor injections with onabotulinumtoxinA

Przydacz¹,

Gołąbek²,

Chłosta³

2019

Adv Clin Exp Med

View full text Add to dashboard Cite

Intra-detrusor injection therapy with onabotulinumtoxinA is generally accepted as a highly effective, minimally invasive and well-tolerated day procedure for patients with refractory overactive bladder (OAB) and neurogenic detrusor overactivity (NDO). The aim of this study was to summarize currently available methods of assessing treatment efficacy and risk factors that may influence the therapeutic effect of this approach. We found that there are discrepancies in the assessment methods. The evaluation of intra-detrusor injections with onabotulinumtoxinA in clinical trials are not always transposable into day-today practice. Moreover, the primary endpoints in clinical trials do not explore the entirety of meaningful patient-centered outcomes. Therefore, in daily clinical practice with patients with overactive bladder syndrome, the therapy should be assessed with objective measures (bladder diaries) and patient-oriented outcomes analyzing the quality of life (questionnaires). In neurogenic individuals, therapeutic efficacy should be additionally evaluated with urodynamic studies. Potential risk factors that may influence the treatment outcomes include urodynamically proven detrusor overactivity, elevated maximum detrusor pressure, greater maximum cystometric capacity, impaired bladder compliance, older age, male gender, a higher baseline bother score, previous anticholinergic treatment, and repeated injections with a subsequent decline in efficacy. The risk of intermittent catheterization following injections seems to depend on the etiology of detrusor overactivity, the injected dose, the injection technique, and the definition of significant post-void residual urine requiring catheterization.

show abstract

“…To evaluate potential predictors of nonresponse to treatment with 200 U BTX-A in women with refractory detrusor overactivity (DO), Owen et al performed a secondary analysis of baseline and 6 week follow-up data (5) of their initial randomized trial of 200 U BTX-A versus placebo in women with refractory DO. 5 Nonresponse to treatment was defined as 20% or less improvement in urinary urgency and leakage episodes, 10% or less in voiding frequency, not achieving continence, and "no change" or worse on patient global impression (PGI)-I score at 6 weeks. Univariate analysis identified cigarette smoking as a risk factor for nonresponse with regard to urinary urgency.…”

Section: Can We Predict Response and Aes Following Botulinum Toxin A?mentioning

confidence: 99%

How can we better manage drug‐resistant OAB/DO? ICI‐RS 2018

Chermansky

Schurch

Rahnama’i

et al. 2019

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims: Botulinum toxin A (BTX-A), sacral nerve stimulation (SNM), and posterior tibial nerve stimulation (PTNS) are established treatments for idiopathic overactive bladder (OAB) refractory to oral drug therapy. At the ICI-RS meeting in Bristol in 2018 a think tank was convened to address the question of how to better manage drug-resistant OAB/DO (detrusor overactivity).Methods: The think tank conducted a literature review and an expert consensus meeting focusing on the evidence for predicting response and adverse events (AEs) with the current therapies for drug-resistant idiopathic OAB.Results: Several factors have been associated with poor outcomes using BTX-A including increasing age, body mass index, male sex, and frailty. Voiding dysfunction with BTX-A also appears to be more prevalent in those with increasing age, male sex, higher baseline postvoid residual and with poorer contractility as assessed by urodynamic parameters. SNM full implantation appears to be higher with the first stage tined lead placement procedure compared to percutaneous nerve evaluation. Urodynamics do not appear to predict outcomes with SNM. Patients with psychiatric comorbidity are more likely to experience AEs with SNM. Outcomes related to lead positioning and the number of active electrodes are mixed in predicting long term success.Patients with increased daytime frequency and lower first sensation of bladder filling were independent factors associated with success with PTNS.Conclusions: Further research is required to optimize these procedures and to better understand which patients will benefit from the various options available in managing refractory OAB. K E Y W O R D Sbotulinum toxin, percutaneous tibial nerve stimulation, sacral neuromodulation S48 |

show abstract

Patient factors associated with onabotulinum toxin A treatment outcome in women with detrusor overactivity

Cited by 10 publications

References 35 publications

Exploring the relation between obesity and urinary incontinence: Pathophysiology, clinical implications, and the effect of weight reduction, ICI‐RS 2018

Exploring the relation between obesity and urinary incontinence: Pathophysiology, clinical implications, and the effect of weight reduction, ICI‐RS 2018

How to assess and predict success or failure of intra-detrusor injections with onabotulinumtoxinA

How can we better manage drug‐resistant OAB/DO? ICI‐RS 2018

Contact Info

Product

Resources

About