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Meta-Analysis
. 2019 Oct;30(10):1603-1617.
doi: 10.1007/s00192-019-04022-8. Epub 2019 Jul 25.

Updating the evidence on drugs to treat overactive bladder: a systematic review

Frances C Hsu  1   2 , Chandler E Weeks  1   2 , Shelley S Selph  1   2 , Ian Blazina  1   2 , Rebecca S Holmes  1   2 , Marian S McDonagh  3   4
Affiliations
Meta-Analysis

Updating the evidence on drugs to treat overactive bladder: a systematic review

Frances C Hsu et al. Int Urogynecol J. 2019 Oct.

Abstract

Introduction: Overactive 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.

Methods: We 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.

Results: In 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.

Conclusion: New 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.

Keywords: Antimuscarinics; Meta-analysis; Mirabegron; Overactive bladder; Systematic review; Urgency urinary incontinence.

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Conflict of interest statement

Financial support statement: An earlier version of this systematic review was funded by the Drug Effectiveness Review Project. The funder participated in development of the scope and key questions, but had no role in selecting or analyzing studies. Updates to the earlier version were unfunded.

Figures

Fig. 1
Fig. 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram
Fig. 2
Fig. 2
Forest plot of change from baseline number of incontinence episodes per 24 h at 12 weeks: mirabegron 50 mg vs. solifenacin 5 mg
Fig. 3
Fig. 3
Forest plot of change from baseline number of micturitions per 24 h at 8 to 12 weeks: mirabegron 50 mg vs. tolterodine extended release (ER) 4 mg
See this image and copyright information in PMC

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