Abstract
IntroductionOveractive bladder (OAB) is a common condition, increasing with age and affecting quality of life. While numerous OAB drugs are available, persistence is low. We evaluated evidence published since 2012 to determine if newer drugs provided better efficacy and harm profiles.MethodsWe searched MEDLINE and the Cochrane Library from 2012 to September 2018 using terms for included drugs and requested information from manufacturers of included drugs. We performed dual review of all systematic review processes, evaluated study quality, and conducted meta-analyses using random effects models.ResultsIn addition to 31 older studies, we included 20 trials published since 2012 (N = 16,478; 4 good, 11 fair, and 5 poor quality). Where statistical differences were found, they were clinically small (reductions of < 0.5 episodes/day). Solifenacin plus mirabegron improved efficacy outcomes over monotherapy with either drug, but significantly increased constipation compared with solifenacin and dry mouth compared with mirabegron. Solifenacin reduced incontinence over mirabegron and tolterodine and urgency episodes over tolterodine. Mirabegron did not differ from tolterodine in efficacy but had significantly lower incidence of dry mouth than solifenacin or tolterodine. Fesoterodine showed significant improvements but also anticholinergic effects vs. tolterodine. Oxybutynin, solifenacin, and tolterodine had similar efficacy, but dry mouth led to greater discontinuation with oxybutynin. Blurred vision, cardiac arrhythmia, and dizziness were uncommon.ConclusionNew evidence confirms small, but clinically uncertain, differences among monotherapies and also between combination and monotherapy, regardless of statistical significance. While drugs mainly differed in incidence of dry mouth or constipation, none provided improved efficacy without increased harms.
Highlights
Overactive bladder (OAB) is a common condition, increasing with age and affecting quality of life
The systematic review was conducted according to the methods developed for Drug Effectiveness Review Project (DERP) [21] and are in accordance with methods established by the US Agency for Healthcare Research and Quality (AHRQ) for the Evidence-based Practice Center (EPC) program [22]
In this systematic review update, we identified 20 new randomized controlled trials (RCTs) [29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69] published since the 31 RCTs included in the 2012 review [20]
Summary
Overactive bladder (OAB) is a common condition, increasing with age and affecting quality of life. While numerous OAB drugs are available, persistence is low. Overactive bladder (OAB) is defined by the International Continence Society as a syndrome of urinary urgency, often. A subset of patients with OAB complains of urgency urinary incontinence (i.e., involuntary leakage accompanied by or immediately preceded by urgency; UUI) and/or stress incontinence (i.e., inability to retain urine when sneezing or coughing), especially women [2, 3]. Men with OAB symptoms often have comorbid bladder outlet obstruction secondary to benign prostatic hyperplasia [4]. Overactive bladder is a common syndrome, and prevalence increases with age. Risk factors for OAB include smoking, obesity, arthritis, depression, heart disease, and irritable bowel syndrome [6].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
