Choosing the Most Efficacious and Safe Oral Treatment for Idiopathic Overactive Bladder: A Systematic Review and Network Meta-analysis
Language English Country Netherlands Media print-electronic
Document type Journal Article, Systematic Review, Research Support, Non-U.S. Gov't, Network Meta-Analysis
PubMed
34563481
DOI
10.1016/j.euf.2021.08.011
PII: S2405-4569(21)00226-1
Knihovny.cz E-resources
- Keywords
- Antimuscarinic agents, Beta-adrenoceptor agonist, Micturition episodes, Network meta-analysis, Overactive bladder, Systematic review, Drug efficacy, Urgency, Urgency urinary incontinence, Volume voided per micturition,
- MeSH
- Receptors, Adrenergic therapeutic use MeSH
- Muscarinic Antagonists therapeutic use MeSH
- Benzhydryl Compounds MeSH
- Urinary Bladder, Overactive * diagnosis drug therapy MeSH
- Urinary Incontinence * drug therapy MeSH
- Humans MeSH
- Solifenacin Succinate adverse effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Network Meta-Analysis MeSH
- Systematic Review MeSH
- Names of Substances
- Receptors, Adrenergic MeSH
- Muscarinic Antagonists MeSH
- Benzhydryl Compounds MeSH
- fesoterodine MeSH Browser
- Solifenacin Succinate MeSH
CONTEXT: The choice of the most efficacious drug for patients with idiopathic overactive bladder (IOAB) remains challenging. OBJECTIVE: The aim of this network meta-analysis was to determine the most efficacious oral antimuscarinic or β-adrenoceptor agonist accounting for adverse events for the management of IOAB. EVIDENCE ACQUISITION: A comprehensive electronic search was done in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Ovid for studies in any language in February 2021 considering the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We included all randomized controlled trials assessing oral antimuscarinics or β-adrenoceptor agonists for the treatment of IOAB. We determined the effect of specific bothersome symptoms separately. EVIDENCE SYNTHESIS: Fifty-four articles were included in our analysis. The most efficacious agents considering the evaluated outcomes were oxybutynin 15 mg/d in reducing incontinence episodes, imidafenacin 0.5 mg/d together with solifenacin 10 and 5 mg/d in reducing micturition episodes, fesoterodine 4 and 8 mg/d as well as solifenacin 10 mg/d in reducing urgency episodes, imidafenacin 0.5 mg/d and solifenacin 10 mg/d in reducing urgency urinary incontinence episodes, and solifenacin 10 mg/d, vibegron 50 mg/d, and fesoterodine 8 mg/d in improving the voided volume. Gastrointestinal problems, especially due to antimuscarinic agents, were the most prevalent adverse events. CONCLUSIONS: Taken together, there is only minimal difference between the efficacy of oral antimuscarinics and that of β-adrenoceptor agonists. Although finding the best medication for all is impossible, finding the best treatment for every individual patient can be done by considering the efficacy of a medicine for the most bothersome symptom(s) in balance with drug-specific adverse events. PATIENT SUMMARY: This study aimed to find the most efficient oral medication to treat overactive bladder, taking into consideration the adverse events. Based on our study, there is a minimal difference in the efficacy between the two major drug classes used to treat overactive bladder. Gastrointestinal problems were the most common adverse events in medical treatment of overactive bladder. Selection of the best treatment is possible through shared decision-making between the doctor and the patient based on the patient's most bothersome symptom. We provide a framework for physicians to facilitate shared decision-making with each individual patient.
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran
References provided by Crossref.org
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