TY - JOUR
T1 - Choosing the Most Efficacious and Safe Oral Treatment for Idiopathic Overactive Bladder
T2 - A Systematic Review and Network Meta-analysis
AU - Mostafaei, Hadi
AU - Salehi-Pourmehr, Hanieh
AU - Jilch, Sandra
AU - Carlin, Greta Lisa
AU - Mori, Keiichiro
AU - Quhal, Fahad
AU - Pradere, Benjamin
AU - Grossmann, Nico C.
AU - Laukhtina, Ekaterina
AU - Schuettfort, Victor M.
AU - Aydh, Abdulmajeed
AU - Sari Motlagh, Reza
AU - König, Frederik
AU - Roehrborn, Claus G.
AU - Katayama, Satoshi
AU - Rajwa, Pawel
AU - Hajebrahimi, Sakineh
AU - Shariat, Shahrokh F.
N1 - Funding Information:
Funding/Support and role of the sponsor: The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 63765 ), on ethical approval code (IR.TBZMED.VCR.REC.1398.280).
Publisher Copyright:
© 2021
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Antimuscarinic agents
KW - Beta-adrenoceptor agonist
KW - Micturition episodes
KW - Network meta-analysis
KW - Overactive bladder
KW - Systematic review, Drug efficacy
KW - Urgency
KW - Urgency urinary incontinence
KW - Volume voided per micturition
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U2 - 10.1016/j.euf.2021.08.011
DO - 10.1016/j.euf.2021.08.011
M3 - Review article
C2 - 34563481
AN - SCOPUS:85116778968
SN - 2405-4569
JO - European Urology Focus
JF - European Urology Focus
ER -