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Meta-Analysis
. 2005 Jul 20;2005(3):CD004742.
doi: 10.1002/14651858.CD004742.pub2.

Serotonin and noradrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults

P Mariappan  1 , Z Ballantyne, J M O N'Dow, A A Alhasso
Affiliations
Meta-Analysis

Serotonin and noradrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults

P Mariappan et al. Cochrane Database Syst Rev. .

Abstract

Background: To date, standard recommendations for the management of stress urinary incontinence (SUI) would be either pelvic floor muscle training (PFMT) or surgery. A new form of drug treatment with a serotonin-noradrenaline reuptake inhibitor (SNRI), duloxetine, may now have a place in treatment of this condition.

Objectives: To determine whether a SNRI is better than placebo (or no treatment, other pharmacological and non-pharmacological therapies, or surgery) in the treatment of women with SUI, or mixed urinary incontinence that includes stress incontinence (MUI), or both and which doses should be used.

Search strategy: We searched the Cochrane Incontinence Group specialised register (searched 1 December 2004), (CENTRAL) (Issue 2, 2004), MEDLINE (January 1966 to September 2004), PREMEDLINE (11 March 2004), Dissertation Abstracts and the reference lists of relevant articles.

Selection criteria: All randomised or quasi-randomised controlled trials of treatment for SUI or MUI, in which at least one management arm involved a SNRI.

Data collection and analysis: Two authors evaluated the trials for appropriateness for inclusion and methodological quality. Three authors performed the data extraction using predetermined criteria. Analyses were performed using the Cochrane Review Manager software, RevMan.

Main results: Nine randomised trials were included, involving 3327 adults with predominantly SUI, randomised to receive duloxetine or placebo. Both arms in individual trials were comparable for various baseline characteristics. Treatment duration was between three weeks and 12 weeks. Duloxetine was significantly better than placebo in terms of improving patients' quality of life (WMD 5.26, 95%CI 3.84 to 6.68. P< 0.00001) and perception of improvement. Individual studies demonstrated a significant reduction in the Incontinence Episode Frequency (IEF) by approximately 50% during treatment with duloxetine. With regard to objective cure, however, meta-analysis of stress pad test and 24 hour pad weight change failed to demonstrate a benefit for duloxetine over placebo though data were relatively few. Subjective cure favoured duloxetine, albeit with a small effect size (3%). One trial suggested that duloxetine was better than pelvic floor muscle training alone in reducing IEF (P < 0.05) based on median percentage decrease in IEF per week. Although significant side effects were commonly associated with duloxetine, they were reported as acceptable.

Authors' conclusions: The available evidence suggests that duloxetine treatment can significantly improve the quality of life of patients with stress urinary incontinence, but it is unclear whether or not benefits are sustainable. Adverse effects are common but not serious. About one in three participants allocated duloxetine reported adverse effects (most commonly nausea) related to treatment, and about one in eight allocated duloxetine stopped treatment as a consequence.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 1 Numbers not cured during treatment.
1.3
1.3. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 3 Numbers not improved during treatment.
1.10
1.10. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 10 Mean reduction in volume/weight of urine loss on pad test on Stress Pad Test.
1.11
1.11. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 11 Mean reduction in volume/weight urine loss on pad test (quantification of symptoms ‐ 24HPW).
1.13
1.13. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 13 Numbers not cured (objective ‐ SPT).
1.14
1.14. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 14 Numbers not cured (objective ‐ CST).
1.15
1.15. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 15 Numbers not cured (objective ‐ Diary).
1.16
1.16. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 16 General health status (I‐QoL).
1.18
1.18. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 18 General Health Status ('very much better', 'much better' or 'a little better' from PGI‐I).
1.19
1.19. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 19 Adverse events.
1.20
1.20. Analysis
Comparison 1 A SNRI is better than placebo or no treatment, Outcome 20 Reduction in incontinence episodes per week ‐ IEF (quantification of symptoms).
2.2
2.2. Analysis
Comparison 2 SNRI is better than conservative non‐pharmacologic therapies, Outcome 2 General Health status (PGI‐I).
2.3
2.3. Analysis
Comparison 2 SNRI is better than conservative non‐pharmacologic therapies, Outcome 3 General health status (I‐QoL).
7.1
7.1. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 1 Numbers not cured during treatment (quantification of symptoms).
7.3
7.3. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 3 Numbers not improved during treatment (quantification of symptoms).
7.10
7.10. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 10 Mean reduction in volume/weight of urine loss on pad test (quantification of symptoms ‐ SPT).
7.11
7.11. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 11 Mean reduction in volume/weight of urine loss on pad test (quantification of symptoms ‐ 24HPW).
7.13
7.13. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 13 Numbers not cured (objective ‐ SPT).
7.14
7.14. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 14 Numbers not cured (objective ‐ CST).
7.15
7.15. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 15 Numbers not cured (objective ‐ Diary).
7.16
7.16. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 16 General health status (I‐QoL).
7.18
7.18. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 18 General Health Status ('Very much better', 'much better' or 'a little better' from PGI‐I).
7.19
7.19. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 19 Numbers experiencing adverse events.
7.20
7.20. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 20 Numbers withdrawing from treatment/trial arm.
7.22
7.22. Analysis
Comparison 7 A higher dose of a SNRI is better than a lower dose, Outcome 22 Reduction in incontinence episodes per week ‐ IEF (quantification of symptoms).
9.2
9.2. Analysis
Comparison 9 SNRI plus conservative non‐pharmacological therapy better than conservative non‐pharmacological therapy alone, Outcome 2 General health status (PGI‐I).
9.3
9.3. Analysis
Comparison 9 SNRI plus conservative non‐pharmacological therapy better than conservative non‐pharmacological therapy alone, Outcome 3 General health status (I‐QoL).
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Update of

References

References to studies included in this review

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References to studies excluded from this review

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