In a nutshell
This study investigated the safety and effectiveness of different anticholinergic medications for overactive bladder (OAB) in women. The authors concluded that anticholinergics lead to modest improvement of OAB symptoms, and rarely fully resolve symptoms.
Some background
Overactive bladder (OAB) affects 1 out of 7 women and can have a significant effect on quality of life and overall well-being. Oral anticholinergic agents are commonly prescribed for OAB. This type of treatment relaxes the muscle of the bladder to prevent it from having spasms. This helps reduce urges to urinate and episodes of urine leakage (incontinence). However, the long-term use of anticholinergics is limited due to their many side effects.
Methods & findings
The effectiveness of this type of therapy among women in particular is the focus of this study.
This analysis included 50 studies that involved more than 27,000 women with OAB. Anticholinergic medications included: oxybutynin (Ditropan), tolterodine (Detrol), fesoterodine (Toviaz), darifenacin (Enablex), solifenacin (Vesicare), and trospium (Sanctura). The average follow-up period of these studies was 12 weeks.
Overall, all medications were effective at improving OAB symptoms. The average number of daily incontinence episodes ranged from no improvement, to 2.5 fewer episodes across all medications. The average number of voids per day ranged from no improvement, to 2.5 fewer voids across all medications. Extended-release trospium improved both symptoms the most, with 2.46 fewer leakage episodes and 2.45 fewer voids per day. Extended-release oxybutynin least improved daily incontinence episodes (0.53), followed by placebo (1.06).
Extended-release medications were modestly better than immediate-release drugs. Average daily leakage episodes decreased by 1.73 with extended-release drugs, versus 1.58 with immediate release drugs. The average number of daily voids decreased by 2.06 (with extended-release) versus 2.17 (with immediate release).
Side effects were reported by 9 to 92% of study participants. The most commonly reported side effects included dry mouth, constipation, and vision changes.
The bottom line
The authors concluded that anticholinergics lead to modest improvement of OAB symptoms, but rarely fully resolve symptoms.
The fine print
41 out of the 50 total studies analyzed here (98%) reported being sponsored by industry. These studies had different designs, reported different outcomes, and were short in duration. These factors may limit the conclusions that can be drawn from these results. Also, few studies directly compared the different anticholinergic medications. This makes it impossible to definitively conclude that any specific agent has superior effectiveness or safety over others.
What’s next?
Consult with your doctor about the potential benefits of anticholinergic medications.
Published By :
Obstetrics and gynecology
Date :
Jun 01, 2015
