The use of oxybutynin in patients treated by means of botulinum neurotoxin A for neurogenic detrusor overactivity: an observational study

Abstract

Study design: This is an observational prospective noncontrolled study. We enrolled 105 patients affected by neurogenic detrusor overactivity (NDO) who underwent botulinum neurotoxin A (BONT-A) intradetrusor injection and were followed-up for 270 days. Objectives: To investigate the use of oxybutynin after BONT-A administration in NDO patients. Setting: Careggi University Hospital in Florence and Tor Vergata University Hospital in Rome. Methods: Prospective data from two Italian centers were collected in 1 year. Patients showing limited efficacy but good tolerability and adherence to oxybutynin 5 mg t.i.d. (three times a day). were enrolled in the study. Patients received BONT-A intradetrusor injection (onabotulinumtoxinA, 300 U) with a trigone-sparing technique, and the use of oxybutynin was registered at every visit. Results: 105 patients were included. At visit 1, only 30 patients (28.6%) used oxybutynin t.i.d., whereas 47 (45,2%) used a lower dosage and 28 (26.7%) stopped the therapy. At visit 2, 77.3% of patients who had reduced oxybutynin intake, maintained the dosage decided at visit 1. At visit 3, 51.9% returned to oxybutynin t.i.d.; 44.8% were on a reduced dosage and only 3 (2.9%) were not taking the drug. At visit 4, only 37.5% of patients were taking less than oxybutynin t.i.d. Conclusion: This study provides some important insights on the use of oral antimuscarinics in patients treated by means of BONT-A intradetrusor administration for NDO; in particular, it suggests that, after an initial reduction in the use of oxybutynin, patients tend to increase the dosage of this drug during the follow-up after the BONT-A treatment.

Long-term response of different Botulinum toxins in refractory neurogenic detrusor overactivity due to spinal cord injury

“…In their prospective observational study on 105 patients, only 23.8% of patients discontinued oral therapy at 120 days, whereas almost 97% of patients were on antimuscarinics with a majority of them (52%) already having returned to oxybutinin t.i.d. within 6 months following 300IU BoNT/A treatment ( 22 ). Similarly, Alvares et al showed that 18 out of 22 subjects (81.8%) continued to use anticholinergics to achieve continence ( 23 ).…”