Comparison of different types of therapy for overactive bladder: A systematic review and network meta-analysis

Abstract

To compare the efficacy and safety of different interventions [including antimuscarinics, mirabegron, OnabotulinumtoxinA, sacral neuromodulation (SNM) and peripheral tibial nerve stimulation (PTNS)] for treating idiopathic overactive bladder (OAB). PubMed, Embase, Cochrane Library, and other sources were searched for randomized controlled trials (RCTs) comparing interventions for overactive bladder from 1 January 2000 to 19 April 2021. A systematic review and network meta-analysis were performed by two authors independently. Fifty-five RCTs involving 32,507 patients were included in this analysis. Overall, antimuscarinics, mirabegron, OnabotulinumtoxinA, sacral neuromodulation, and peripheral tibial nerve stimulation were more efficacious than placebo, and sacral neuromodulation showed the best effect for reducing micturition frequency, urgency episodes and urgency urinary incontinence episodes. OnabotulinumtoxinA was the best intervention for achieving reductions of 100 and ≥50% in the number of urinary incontinence episodes/day, and peripheral tibial nerve stimulation was the best intervention for reducing urinary incontinence episodes. Antimuscarinics, mirabegron and peripheral tibial nerve stimulation had a similar efficacy for reducing micturition frequency, urinary incontinence episodes and urgency urinary incontinence episodes. The results revealed that all interventions examined herein were efficacious for managing adult overactive bladder syndrome compared with placebo. Furthermore, sacral neuromodulation and OnabotulinumtoxinA were the most efficient treatments for overactive bladder.

Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=251966], identifier [CRD42021251966].

Keywords: antimuscarinics; mirabegron; network meta-analysis; overactive bladder; peripheral tibial nerve stimulation; sacral neuromodulation (SNM).

FIGURE 1

Study design.

FIGURE 2

Pairwise meta-analyses result for different endpoints. (A) Pairwise meta-analyses result for reducing micturition frequency/day, urgency urinary incontinence episodes (UUIE)/day, urgency episodes/day, urinary incontinence episodes (UIE)/day; (B) Pairwise meta-analyses result for 100 and ≥50% reduction from baseline in urinary incontinence episodes (UIE)/day. SNM, sacral neuromodulation; PTNS, peripheral tibial nerve stimulation.

FIGURE 3

Network plots of (A) mean change in the frequency of micturition/day; (B) mean change in urgency urinary incontinence episodes (UUIE)/day; (C) mean change in urinary incontinence episodes (UIE)/day; (D) mean change in urgency/day; (E) ≥50% reductions from baseline in urinary incontinence episodes (UIE)/day; (F) 100% reductions from baseline in urinary incontinence episodes (UIE)/day. These plots were made by Stata 16.0. Each circular node represents a type of treatment. Each line shows a type of head-to-head comparison. Node size and line thickness are weighted according to the number of studies evaluating each treatment and direct comparison, respectively. The total number of participants receiving a treatment is shown in brackets. SNM, sacral neuromodulation; PTNS, peripheral tibial nerve stimulation.

FIGURE 4

Network meta-analysis on the outcomes of interests. Data in (A) and (B) are SMD (95% CI) for the comparison of row-defining treatment versus column-defining treatment. SMD less than 0 favors upper-row treatment. Data in (C) are OR (95% CI) for the comparison of row-defining treatment versus column-defining treatment. OR more than 1 favors upper-row treatment. Significant results are highlighted in bold; second line treatment are highlighted in blue; third line treatment are highlighted in yellow. SNM, sacral neuromodulation; PTNS, peripheral tibial nerve stimulation.

FIGURE 5

Rank probabilities of (A) mean change in the frequency of micturition/day; (B) mean change in urgency urinary incontinence episodes (UUIE)/day; (C) mean change in urinary incontinence episodes (UIE)/day; (D) mean change in urgency/day; (E) ≥50% reductions from baseline in urinary incontinence episodes (UIE)/day; (F) 100% reductions from baseline in urinary incontinence episodes (UIE)/day. The X-axis represents the ranking, and the Y-axis represents the possibility of the ranking. These plots were made by GraphPad Prism 8. SNM, sacral neuromodulation; PTNS, peripheral tibial nerve stimulation.