More data are needed to use BTX A as first-line treatment

Abstract

Dr. Steele succinctly summarizes the efficacy and safety of Botulinum toxin A (BTX A) – a point which is not in debate.1 However, the use of BTX A as a primary modality of treatment for OAB has never been reported. While it is likely that BTX A will be able to control overactivity in anticholinergic naive patients, it is unclear what side effects, such as urinary retention, will be seen in such a group. Research into patient preferences and decision-making as it relates to the weighted value of the invasiveness of intervention and side effects balanced with overall levels of improvement in symptoms would yield insight. A randomized trial between BTX A and an anti-cholinergic medication in patients with moderate to severe OAB with detrusor overactivity who are naive to treatment may be reasonable to address this issue, especially in the subset of neurogenic OAB who are already intermittently catheterizing. For the time being, there is no data to support the use of BTX A as a primary treatment for OAB. The long-term success beyond 10 years of BTX A for OAB is unknown. Thus, patients should continue to be treated in a stepwise fashion beginning with lifestyle and behavioural changes, and oral pharmacotherapy.