Anticholinergic drugs for adult neurogenic detrusor overactivity

a systematic review and meta-analysis

Priya Madhuvrata, Manju Singh, Zaid Hasafa, Mohamed Abdel-Fattah

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Context
There is a lack of evidence about the efficacy and safety of anticholinergic drugs and about the optimal anticholinergic drug, if any, for the treatment of adult neurogenic detrusor overactivity (NDO).

Objective
Review the current evidence on the efficacy, safety, and tolerability of anticholinergic drugs in the treatment of adult NDO.

Evidence acquisition
A literature search was conducted from 1966 to May 2011. Meta-analysis of all published randomised controlled trials (RCTs) comparing anticholinergic drugs with placebo and comparing different types, doses, and routes of administration of anticholinergic drugs, in adults with NDO, was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The primary outcome was patient-reported cure/improvement of overactive bladder symptoms. Secondary outcomes were quality of life (QoL) changes, bladder diary events, urodynamic outcomes, adverse events, and costs to health services.

Evidence synthesis
A total of 960 patients from 16 RCTs with mean follow-up of 3.8 wk were included. Anticholinergic drugs were associated with statistically significantly better patient-reported cure/improvement (risk ratio: 2.80; 95% confidence interval [CI], 1.64 to 4.77), higher maximum cystometric capacity (weighted mean difference [WMD]: 49.49; 95% CI, 15.38 to 84.20), higher volume at first contraction (WMD: 49.92; 95% CI, 20.06 to 79.78), and lower maximum detrusor pressure (WMD: -38.30; 95% CI, -53.17 to -23.43) when compared with placebo. The dry-mouth rates were statistically significantly higher with anticholinergics, with no difference in withdrawals because of adverse events. There was no statistically significant difference in any of the outcomes between oxybutynin and other anticholinergics or among different doses and preparations of anticholinergic drugs. No study reported QoL changes or costs to health services.

Conclusions
Compared with placebo, anticholinergic treatment in patients with NDO is associated with better patient-reported cure/improvement and significant reduction of maximum detrusor pressure; however, there is a higher incidence of adverse events. None of the anticholinergic drugs or different dosages assessed in this review was superior to another.
Original languageEnglish
Pages (from-to)816-830
Number of pages15
JournalEuropean Urology
Volume62
Issue number5
Early online date24 Feb 2012
DOIs
Publication statusPublished - Nov 2012

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Cholinergic Antagonists
Meta-Analysis
Pharmaceutical Preparations
Confidence Intervals
Placebos
Health Services
Randomized Controlled Trials
Quality of Life
Drug Administration Routes
Safety
Pressure
Costs and Cost Analysis
Overactive Urinary Bladder
Drug Compounding
Urodynamics
Mouth
Urinary Bladder
Therapeutics
Odds Ratio

Keywords

  • neurogenic detrusor overactivity
  • anticholinergics
  • detrusor hyperreflexia
  • neurogenic bladder
  • antimuscarinics

Cite this

Anticholinergic drugs for adult neurogenic detrusor overactivity : a systematic review and meta-analysis. / Madhuvrata, Priya; Singh, Manju; Hasafa, Zaid; Abdel-Fattah, Mohamed.

In: European Urology, Vol. 62, No. 5, 11.2012, p. 816-830.

Research output: Contribution to journalArticle

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abstract = "Context There is a lack of evidence about the efficacy and safety of anticholinergic drugs and about the optimal anticholinergic drug, if any, for the treatment of adult neurogenic detrusor overactivity (NDO). Objective Review the current evidence on the efficacy, safety, and tolerability of anticholinergic drugs in the treatment of adult NDO. Evidence acquisition A literature search was conducted from 1966 to May 2011. Meta-analysis of all published randomised controlled trials (RCTs) comparing anticholinergic drugs with placebo and comparing different types, doses, and routes of administration of anticholinergic drugs, in adults with NDO, was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The primary outcome was patient-reported cure/improvement of overactive bladder symptoms. Secondary outcomes were quality of life (QoL) changes, bladder diary events, urodynamic outcomes, adverse events, and costs to health services. Evidence synthesis A total of 960 patients from 16 RCTs with mean follow-up of 3.8 wk were included. Anticholinergic drugs were associated with statistically significantly better patient-reported cure/improvement (risk ratio: 2.80; 95{\%} confidence interval [CI], 1.64 to 4.77), higher maximum cystometric capacity (weighted mean difference [WMD]: 49.49; 95{\%} CI, 15.38 to 84.20), higher volume at first contraction (WMD: 49.92; 95{\%} CI, 20.06 to 79.78), and lower maximum detrusor pressure (WMD: -38.30; 95{\%} CI, -53.17 to -23.43) when compared with placebo. The dry-mouth rates were statistically significantly higher with anticholinergics, with no difference in withdrawals because of adverse events. There was no statistically significant difference in any of the outcomes between oxybutynin and other anticholinergics or among different doses and preparations of anticholinergic drugs. No study reported QoL changes or costs to health services. Conclusions Compared with placebo, anticholinergic treatment in patients with NDO is associated with better patient-reported cure/improvement and significant reduction of maximum detrusor pressure; however, there is a higher incidence of adverse events. None of the anticholinergic drugs or different dosages assessed in this review was superior to another.",
keywords = "neurogenic detrusor overactivity, anticholinergics, detrusor hyperreflexia, neurogenic bladder, antimuscarinics",
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T1 - Anticholinergic drugs for adult neurogenic detrusor overactivity

T2 - a systematic review and meta-analysis

AU - Madhuvrata, Priya

AU - Singh, Manju

AU - Hasafa, Zaid

AU - Abdel-Fattah, Mohamed

PY - 2012/11

Y1 - 2012/11

N2 - Context There is a lack of evidence about the efficacy and safety of anticholinergic drugs and about the optimal anticholinergic drug, if any, for the treatment of adult neurogenic detrusor overactivity (NDO). Objective Review the current evidence on the efficacy, safety, and tolerability of anticholinergic drugs in the treatment of adult NDO. Evidence acquisition A literature search was conducted from 1966 to May 2011. Meta-analysis of all published randomised controlled trials (RCTs) comparing anticholinergic drugs with placebo and comparing different types, doses, and routes of administration of anticholinergic drugs, in adults with NDO, was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The primary outcome was patient-reported cure/improvement of overactive bladder symptoms. Secondary outcomes were quality of life (QoL) changes, bladder diary events, urodynamic outcomes, adverse events, and costs to health services. Evidence synthesis A total of 960 patients from 16 RCTs with mean follow-up of 3.8 wk were included. Anticholinergic drugs were associated with statistically significantly better patient-reported cure/improvement (risk ratio: 2.80; 95% confidence interval [CI], 1.64 to 4.77), higher maximum cystometric capacity (weighted mean difference [WMD]: 49.49; 95% CI, 15.38 to 84.20), higher volume at first contraction (WMD: 49.92; 95% CI, 20.06 to 79.78), and lower maximum detrusor pressure (WMD: -38.30; 95% CI, -53.17 to -23.43) when compared with placebo. The dry-mouth rates were statistically significantly higher with anticholinergics, with no difference in withdrawals because of adverse events. There was no statistically significant difference in any of the outcomes between oxybutynin and other anticholinergics or among different doses and preparations of anticholinergic drugs. No study reported QoL changes or costs to health services. Conclusions Compared with placebo, anticholinergic treatment in patients with NDO is associated with better patient-reported cure/improvement and significant reduction of maximum detrusor pressure; however, there is a higher incidence of adverse events. None of the anticholinergic drugs or different dosages assessed in this review was superior to another.

AB - Context There is a lack of evidence about the efficacy and safety of anticholinergic drugs and about the optimal anticholinergic drug, if any, for the treatment of adult neurogenic detrusor overactivity (NDO). Objective Review the current evidence on the efficacy, safety, and tolerability of anticholinergic drugs in the treatment of adult NDO. Evidence acquisition A literature search was conducted from 1966 to May 2011. Meta-analysis of all published randomised controlled trials (RCTs) comparing anticholinergic drugs with placebo and comparing different types, doses, and routes of administration of anticholinergic drugs, in adults with NDO, was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The primary outcome was patient-reported cure/improvement of overactive bladder symptoms. Secondary outcomes were quality of life (QoL) changes, bladder diary events, urodynamic outcomes, adverse events, and costs to health services. Evidence synthesis A total of 960 patients from 16 RCTs with mean follow-up of 3.8 wk were included. Anticholinergic drugs were associated with statistically significantly better patient-reported cure/improvement (risk ratio: 2.80; 95% confidence interval [CI], 1.64 to 4.77), higher maximum cystometric capacity (weighted mean difference [WMD]: 49.49; 95% CI, 15.38 to 84.20), higher volume at first contraction (WMD: 49.92; 95% CI, 20.06 to 79.78), and lower maximum detrusor pressure (WMD: -38.30; 95% CI, -53.17 to -23.43) when compared with placebo. The dry-mouth rates were statistically significantly higher with anticholinergics, with no difference in withdrawals because of adverse events. There was no statistically significant difference in any of the outcomes between oxybutynin and other anticholinergics or among different doses and preparations of anticholinergic drugs. No study reported QoL changes or costs to health services. Conclusions Compared with placebo, anticholinergic treatment in patients with NDO is associated with better patient-reported cure/improvement and significant reduction of maximum detrusor pressure; however, there is a higher incidence of adverse events. None of the anticholinergic drugs or different dosages assessed in this review was superior to another.

KW - neurogenic detrusor overactivity

KW - anticholinergics

KW - detrusor hyperreflexia

KW - neurogenic bladder

KW - antimuscarinics

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DO - 10.1016/j.eururo.2012.02.036

M3 - Article

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SP - 816

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JO - European Urology

JF - European Urology

SN - 0302-2838

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