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Sahai A, Robinson D, Abrams P, Wein A, Malde S. What is the best first choice oral drug therapy for OAB? Neurourol Urodyn 2024; 43:1328-1336. [PMID: 38270332 DOI: 10.1002/nau.25397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
AIMS The management of overactive bladder (OAB) involves lifestyle changes and conservative measures in the first instance with the use of liquid/dietary advice, weight loss, and bladder training. Thereafter oral pharmacotherapy is instigated in symptomatic patients. Antimuscarinics and beta 3 agonists form the main classes of drug therapy in this field. Views on what is the best first line OAB treatment is changing based on recent evidence and adverse event profiles of these medications. METHODS At the ICI-RS meeting 2023, Bristol, UK this topic was discussed and debated as a proposal. The following article summarizes the concepts presented that day as well as the interactive discussion that took place thereafter. RESULTS OAB guidelines are moving in many circumstances to an either antimuscarinic or beta 3 agonist approach based on patient factors. Several studies have raised concerns on the long-term impact of antimuscarinics, in relation to cognition, dementia, cardiovascular events, and mortality all related to antimuscarinic load. Neither antimuscarinics nor beta 3 agonists have good persistence and adherence rates in the medium to long term. Several barriers also exist to prescribing including guidelines recommending utilizing drugs with the lowest acquisition cost and "step therapy." A newer approach to managing OAB is personalized therapy in view of the many possible etiological factors and phenotypes. These concepts are highlighted in this article. CONCLUSIONS Current oral pharmacotherapy in managing OAB is limited by adverse events, adherence and persistence problems. Both antimuscarinics and beta 3 agonists are efficacious but most clinical trials demonstrate significant placebo effects in this field. Personalizing treatment to the individual seems a logical approach to OAB. There is a need for better treatments and further studies are required of existing treatments with high quality longer term outcomes.
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Affiliation(s)
- Arun Sahai
- Department of Urology, Guy's Hospital & King's College, London, UK
| | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital & King's College, London, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
- University of Bristol, Bristol, UK
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami Miller School of medicine, Miami, Florida, USA
- University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sachin Malde
- Department of Urology, Guy's Hospital & King's College, London, UK
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Khadour FA, Khadour YA, Alhatem W, Al Barroush D. Risk factors associated with the severity of overactive bladder among Syrian patients with type 2 diabetes. Sci Rep 2024; 14:16547. [PMID: 39020001 PMCID: PMC11255225 DOI: 10.1038/s41598-024-67326-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
The prevalence of overactive bladder (OAB) is known to be higher in patients with type 2 diabetes (T2DM). However, few studies have examined specific risk factors contributing to its progression among diabetes mellitus (DM) patients, so this study aimed to investigate the risk factors specific to diabetes mellitus that influence overactive bladder in the Syrian population. This cross-sectional study was conducted at four endocrinology centers in four Syrian provinces: Damascus, Aleppo, Homs, Hama, and Latakia. The study was comprised of patients who had been diagnosed with both T2DM and OAB and had visited these centers from February 2020 to January 2023. The Arabic version of the Overactive Bladder Symptom Score (OABSS) scale was used to categorize the participants based on the severity score into two groups: the mild OAB group and the moderate-severe OAB group. A logistic analysis was conducted to assess the risk factors associated with the OAB among patients with diabetes. Among the 153 patients diagnosed with both DM and OAB, significant distinctions were found between the two groups concerning the severity of overactive bladder, age, duration of diabetes, symptomatic diabetic peripheral neuropathy (DPN), and ankle reflex (P < 0.05). Furthermore, a multivariate analysis revealed that age (OR 1.48, 95% CI 0.89-2.19), duration of diabetes (OR 1.94, 95% CI 0.53-2.23), and symptomatic DPN (OR 2.74, 95% CI 1.39-4.13) independently acted as risk factors for the advancement of OAB. The severity of OAB in Syrian patients with diabetes is closely associated with the severity of DM. Factors such as age, duration of diabetes, and symptomatic DPN are independent predictors of the severity of OAB. Patients who experience symptomatic DPN are at an increased risk of developing OAB.
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Affiliation(s)
- Fater A Khadour
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China.
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria.
| | - Younes A Khadour
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria
- Department of Physical Therapy, Cairo University, Cairo, 11835, Egypt
| | - Weaam Alhatem
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria
| | - Deema Al Barroush
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria
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Cameron AP, Chung DE, Dielubanza EJ, Enemchukwu E, Ginsberg DA, Helfand BT, Linder BJ, Reynolds WS, Rovner ES, Souter L, Suskind AM, Takacs E, Welk B, Smith AL. The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. Neurourol Urodyn 2024. [PMID: 39010271 DOI: 10.1002/nau.25532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE The purpose of this guideline is to provide evidence-based guidance to clinicians of all specialties on the evaluation, management, and treatment of idiopathic overactive bladder (OAB). The guideline informs the reader on valid diagnostic processes and provides an approach to selecting treatment options for patients with OAB through the shared decision-making process, which will maximize symptom control and quality of life, while minimizing adverse events and burden of disease. METHODS An electronic search employing OVID was used to systematically search the MEDLINE and EMBASE databases, as well as the Cochrane Library, for systematic reviews and primary studies evaluating diagnosis and treatment of OAB from January 2013 to November 2023. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest. Following the study selection process, 159 studies were included and were used to inform evidence-based recommendation statements. RESULTS This guideline produced 33 statements that cover the evaluation and diagnosis of the patient with symptoms suggestive of OAB; the treatment options for patients with OAB, including Noninvasive therapies, pharmacotherapy, minimally invasive therapies, invasive therapies, and indwelling catheters; and the management of patients with BPH and OAB. CONCLUSION Once the diagnosis of OAB is made, the clinician and the patient with OAB have a variety of treatment options to choose from and should, through shared decision-making, formulate a personalized treatment approach taking into account evidence-based recommendations as well as patient values and preferences.
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Affiliation(s)
- Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Doreen E Chung
- Department of Urology, Columbia University, New York, New York
| | - Elodi J Dielubanza
- Department of Urology, University of Southern California, Palo Alto, California
| | - Ekene Enemchukwu
- Department of Urology, Stanford University School of Medicine, Palo Alto, California
| | - David A Ginsberg
- Department of Urology, University of Southern California, Los Angeles, California
| | | | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - W Stuart Reynolds
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Lesley Souter
- Nomadic EBM Methodology, Smithville, Ontario, Canada
| | - Anne M Suskind
- Department of Urology, University of California, San Francisco, San Francisco, California
| | | | - Blayne Welk
- Department of Surgery and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Ariana L Smith
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
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Mut SE, Selcuk F, İncirli SU, Delibas S. Efficacy and Safety of Mirabegron Add-on Therapy After Failure With Solifenacin in Multiple Sclerosis Patients With Overactive Bladder: A Pilot Study. Clin Neuropharmacol 2024; 47:109-112. [PMID: 39008540 DOI: 10.1097/wnf.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative progressive disease of central nervous system that mostly affects young adults. (1) Because of involvement of spinal cord and brain, lower urinary dysfunction symptoms are commonly encountered. MS patients mostly show overactive bladder symptoms like urgency, frequent daytime urination, and urgency incontinence. Among MS patients, antimuscarinic therapy is the first-line treatment with overactive bladder symptoms as well as in general population yet 30% of the patients show insufficient improvement or intolerance to the treatment (2). In our study, our aim is to evaluate the efficacy and safety of mirabegron add-on treatment in MS patients after inadequate response to antimuscarinic monotherapy. METHODS University of Kyrenia and Dr Burhan Nalbantoglu State hospital's databases were screened for the study. Seventy patients who were residents diagnosed with MS according to McDonald criteria were questioned. Among these patients, a total of 22 of them were included in the study. Inclusion criteria was at least 3 years of MS diagnosis, score of <6 at Expanded Disability Status Scale, and a score of ≥3 at Overactive Bladder Symptom Score Scale. RESULTS Among selected patients, 10 mg solifenacin treatment was daily started and followed for 4 weeks. Mirabegron add-on treatment was initiated to the 11 patient who had inadequate improvement in overactive bladder symptom score. After mirabegron add-on treatment among 11 patient, there was a sufficient improvement in overactive bladder symptom score ( P < 0.008). CONCLUSIONS In our study, we have found that antimuscarinic and mirabegron combination causes improved efficacy for overactive bladder in MS population.
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Affiliation(s)
- Senem Ertugrul Mut
- University of Kyrenia, Faculty of Medicine, Department of Neurology, Kyrenia, Northern Cyprus
| | - Ferda Selcuk
- European University of Lefke, Vocational school of Health Services, Lefke, Northern Cyprus, Mersin, Turkey
| | - Sila Usar İncirli
- Dr Burhan Nalbantoglu State Hospital, Department of Neurology, Nicosia, Northern Cyprus
| | - Sedef Delibas
- University of Kyrenia, Faculty of Medicine, Kyrenia, Northern Cyprus
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Neuner J, Schmitt E, Winn A, Davidson E, O'Connor RC, Marowski S, Luebke M, Balza J, Attewell M, Flynn KE. Urinary Incontinence Medications: Patient-Initiated Concerns in Primary Care. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00241. [PMID: 38954604 DOI: 10.1097/spv.0000000000001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
IMPORTANCE Guideline-recommended medications for overactive bladder and urge urinary incontinence (OAB/UUI) are effective but have high costs and side effects. Little is known about patient concerns regarding these medications when prescribed by their primary care providers (PCPs). OBJECTIVE The aim of the study was to describe PCP-patient interactions when prescribing medications for OAB/UUI, specifically clinical concerns, cost and authorization issues, and mode of communication for these interactions. STUDY DESIGN Using electronic health records, we identified a retrospective cohort of women aged 18-89 years who were prescribed a medication for OAB/UUI during a primary care office visit from 2017 to 2018. We examined the electronic health record from initial prescription through 15 subsequent months for documentation of prior authorization requests and patient concerns about cost, side effects, or ineffectiveness. The association of patient demographics, comorbidity, and medication class with these concerns was examined with logistic regression models. RESULTS Overall, 46.2% of patients (n = 123) had 1 or more OAB/UUI medication concerns, and 52 reported outside an office visit. Only higher comorbidity was associated with reduced concern of any type. Although the overall percent age of patients reporting concerns was similar by medication type, the patterns of concern type varied. Compared with those taking short-acting antimuscarinics, patients taking long-acting antimuscarinics other than oxybutynin were less likely to have side effect concerns (adjusted odds ratio 0.35, 95% CI 0.16-0.78) and more likely to have cost concerns (adjusted odds ratio 5.10, 95% CI 1.53-17.03). CONCLUSIONS Patient concerns regarding OAB/UUI medications were common in primary care practices and frequently reported outside of office visits. However, the patterns of concerns (cost vs side effects) varied between medication classes.
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Affiliation(s)
- Joan Neuner
- From the Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Emily Schmitt
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Aaron Winn
- Department of Pharmacy Systems, Outcomes and Policy, School of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Emily Davidson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | | | - Madeline Attewell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Kathryn E Flynn
- From the Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Evans CNB, Badenhorst A, Van Wijk FJ. The impact of pharmacotherapy on sexual function in female patients being treated for idiopathic overactive bladder: a systematic review. BMC Womens Health 2024; 24:290. [PMID: 38755593 PMCID: PMC11097459 DOI: 10.1186/s12905-024-03103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Overactive bladder (OAB) is a condition defined by urgency with or without incontinence which disproportionately affects female patients and has a negative impact on sexual enjoyment and avoidance behaviour. Pharmacotherapy can be considered one of the main options for treating OAB. This research set out to determine the impact of pharmacotherapy on sexual function in females with OAB. METHODS This research used the robust methodology of a systematic review. The clinical question was formulated using the PICO (population, intervention, control, and outcomes) format to include females being treated with pharmacotherapy (anticholinergics or beta-3 adrenergic agonists) for idiopathic OAB with the use of a validated questionnaire assessing self-reported sexual function at baseline and post-treatment. The review incorporated the MEDLINE, PubMed and EMBASE databases. The AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) appraisal tool was used to guide the review process. Two reviewers worked independently in screening abstracts, deciding on the inclusion of full-texts, data extraction and risk of bias assessment. RESULTS In female patients with OAB, pharmacotherapy does seem to offer at least partial improvement in self-reported sexual function outcomes after 12 weeks of therapy. Still, the value of this finding is limited by an overall poor quality of evidence. Patients with a higher degree of bother at baseline stand to benefit the most from treatment when an improvement within this health-related quality of life domain is sought. CONCLUSION This research should form the basis for a well-conducted randomized controlled study to accurately assess sexual function improvements in females being treated with pharmacotherapy for OAB.
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Affiliation(s)
- Christopher Neal Bruce Evans
- Surgery Masters in Urology, the University of Edinburgh (Edinburgh Surgery Online, Deanery of Clinical Sciences) and Life Groenkloof Hospital, Suite 209, Life Groenkloof Hospital, 50 George Storrar Drive, Groenkloof, Pretoria, 0181, South Africa.
| | - Anja Badenhorst
- General Practitioner, University of Pretoria, Pretoria, South Africa
| | - Frans Jacob Van Wijk
- Private Uro-Gynaecologist/Urologist, Pelvic Wellness Unit, The Urology Hospital, Pretoria, South Africa
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Chastek B, Carrera A, Landis C, Snyder D, Abedinzadeh L, Bancroft T, Nesheim J, Kennelly M, Staskin D. Real-World Adherence to and Persistence with Vibegron in Patients with Overactive Bladder: A Retrospective Claims Analysis. Adv Ther 2024; 41:2086-2097. [PMID: 38520502 PMCID: PMC11052770 DOI: 10.1007/s12325-024-02824-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Vibegron is a β3-adrenergic receptor agonist approved for overactive bladder (OAB). This analysis assessed real-world adherence and persistence with vibegron in patients with OAB, along with demographics and clinical characteristics associated with adherence and persistence. METHODS This retrospective study used the Optum Research Database to identify patients treated with vibegron from April 2021 to August 2022 (identification period). Patients had ≥ 60 days of continuous pharmacy coverage in a commercial or Medicare Advantage plan following the index fill (follow-up). Adherence was assessed as proportion of days covered (PDC) from index to end of follow-up and was defined as PDC ≥ 80%. Persistence was measured as days to discontinuation of therapy (30-day gap) or end of follow-up. Data for adherence and persistence are presented descriptively. Characteristics associated with adherence and persistence were analyzed using multivariable models among patients with medical and pharmacy benefits during the 90 days before index (baseline). RESULTS Overall, 9992 patients had a vibegron claim during the identification period; 9712 had ≥ 2 months of follow-up. Mean (SD) age was 74.2 (10.7) years; 68.2% were female. Mean (SD) PDC was 0.64 (0.34). Median (95% confidence interval) persistence was 142 (132-153) days. Of the 5073 patients who were ≥ 18 years old with continuous baseline pharmacy and medical benefits ≥ 90 days before index, 2497 (49.2%) were adherent. Patients were more likely to be adherent and persistent if they received a greater days' supply for the index fill and had baseline medication count ≥ 6. Patients were more likely to discontinue if their index copay was > $45. CONCLUSION Nearly half of the patients initiating vibegron were adherent. Factors associated with adherence and persistence were more likely to be related to prescribing practices than patient characteristics. These results suggest it may be best to follow up with patients approximately 4 to 5 months after initiating treatment with vibegron.
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Affiliation(s)
| | - Adam Carrera
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA.
| | | | - Daniel Snyder
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA
| | - Laleh Abedinzadeh
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA
| | | | - Jeffrey Nesheim
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA
| | | | - David Staskin
- Tufts University School of Medicine, Boston, MA, USA
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Oh SJ, Cho ST, Kuo HC, Chou ECL, Hsu YC, Lee KS, Hadi F, Song Y, Sumarsono B. Treatment Patterns with Mirabegron and Antimuscarinics for Overactive Bladder: A Prospective, Registry Study in Taiwan and South Korea (FAITH). Adv Ther 2024; 41:1652-1671. [PMID: 38430402 PMCID: PMC10960886 DOI: 10.1007/s12325-024-02784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/11/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This study aimed to assess overactive bladder (OAB) treatment patterns and factors associated with effectiveness and persistence. METHODS A prospective, longitudinal, observational registry study of adults starting OAB therapy with mirabegron or antimuscarinics was undertaken. Primary endpoints were time from treatment initiation to discontinuation/switching; proportion who discontinued/switched; and reasons for discontinuation/switching. Secondary endpoints included OAB Symptom Score (OABSS), OAB Questionnaire: Short Form, and OAB Bladder Assessment Tool scores; factors associated with effectiveness and persistence; and safety. RESULTS In total, 556 patients initiating mirabegron and 250 initiating antimuscarinics were enrolled. There was no treatment switch, change, or discontinuation in 68.5% of the mirabegron initiator group and median time to treatment change was not reached. Mean initial treatment duration was 130.8 days. In multivariable models, baseline OABSS was the only variable significantly associated with change from baseline in OABSS, and patients with mild and moderate OAB had significantly better persistence with mirabegron than those with severe OAB. Urinary tract infection was the most common adverse event with mirabegron. There was no treatment switch, change, or discontinuation in 60.4% of the antimuscarinics initiator group and median time to treatment change was not reached. Solifenacin was the most frequent initial treatment (66.0%). Mean treatment duration was 122.2 days. In multivariable models, baseline OABSS was the only variable significantly associated with change from baseline in OABSS, while patients with OAB medication in the 12 months before enrollment had significantly better persistence with antimuscarinics than those with no previous OAB medication. Dry mouth was the most common adverse event with antimuscarinics. CONCLUSIONS Mirabegron and solifenacin were commonly prescribed as first-line OAB medications. There was no treatment switch, change, or discontinuation in more than 60% of the mirabegron initiator and antimuscarinics initiator groups. Mean initial treatment duration was 130.8 days and 122.2 days for mirabegron and antimuscarinics, respectively. Graphical Abstract available for this article. TRIAL REGISTRATION ClinicalTrials.gov NCT03572231.
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Affiliation(s)
- Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | | | - Yu-Chao Hsu
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Farid Hadi
- Astellas Pharma Medical Affairs, Singapore, Singapore
| | - Yi Song
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
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Heuer CW, Gisseman JD, Vaccaro CM, Olsen CH, Galgano AC, Dengler KL. Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:272-279. [PMID: 38484242 DOI: 10.1097/spv.0000000000001466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Urinary tract infections (UTIs) occur in 8.6% to 48.1% of patients after intradetrusor onabotulinumtoxinA injections. OBJECTIVE The objective of this study was to evaluate both choice and duration of antibiotic prophylaxis on the incidence of UTI within 30 days after in-office onabotulinumtoxinA injections. STUDY DESIGN We included a single-site, retrospective cohort of 305 patients with overactive bladder or bladder pain syndrome receiving postprocedure prophylactic antibiotics for in-office, 100-unit intradetrusor onabotulinumtoxinA injections from 2019 to 2023. Categories of antibiotic prophylaxis compared included (1) nitrofurantoin 100 mg twice daily for 3 days, (2) nitrofurantoin 100 mg twice daily for 5 days, (3) trimethoprim-sulfamethoxazole 160 mg/800 mg twice daily for 3 days, and (4) "other regimens." Primary outcome was incidence of UTI within 30 days. Variables were compared via χ2 test. Crude/adjusted odds were estimated using binary logistic regression. RESULTS Incidence of UTI was 10.4% for 3-day nitrofurantoin, 20.5% for 5-day nitrofurantoin, 7.4% for 3-day trimethoprim-sulfamethoxazole, and 25.7% among "other regimens" (P = 0.023). Differences among primary regimens were substantial but not statistically significant: 3-day trimethoprim-sulfamethoxazole had 31% lower odds of UTI versus 3-day nitrofurantoin (odds ratio [OR], 0.689; P = 0.518). Compared with 3-day nitrofurantoin regimen, the 5-day nitrofurantoin regimen had twice the odds of UTI (OR, 2.22; P = 0.088). Those receiving "other regimens" had nearly 3 times the odds of UTI (OR, 2.98; P = 0.018). Results were similar adjusting for age and race. Overall urinary retention rate was 1.97%. CONCLUSIONS Prophylactic antibiotic choice and duration of treatment potentially affect UTI incidence after in-office, intradetrusor onabotulinumtoxinA injections. Nitrofurantoin and trimethoprim-sulfamethoxazole for 3 days have the lowest UTI incidence.
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Affiliation(s)
- Christopher W Heuer
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
| | - Jordan D Gisseman
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
| | - Christine M Vaccaro
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
| | - Cara H Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD
| | - Alissa C Galgano
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
| | - Katherine L Dengler
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
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Carter-Brooks CM, Brown OE, Ackenbom MF. Pelvic Floor Disorders in Black Women: Prevalence, Clinical Care, and a Strategic Agenda to Prioritize Care. Obstet Gynecol Clin North Am 2024; 51:157-179. [PMID: 38267125 PMCID: PMC11093648 DOI: 10.1016/j.ogc.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Pelvic floor disorders are a group of common conditions affecting women of all racial and ethnic groups. These disorders are undertreated in all women, but this is especially magnified in Black people who have been historically marginalized in the United States. This article seeks to highlight the prevalence of pelvic floor disorders in Black women, evaluate the clinical care they receive, examine barriers they face to equitable care, and present a strategic agenda to prioritize the care of Black women with pelvic floor disorders.
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Affiliation(s)
- Charelle M Carter-Brooks
- The George Washington School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Suite 6A- 416, Washington, DC 20037, USA.
| | - Oluwateniola E Brown
- Northwestern University Feinberg School of Medicine, 250 East Superior Avenue Suite 05-2113, Chicago, IL 60601, USA
| | - Mary F Ackenbom
- Magee-Womens Research Institute, University of Pittsburgh, 3240 Craft Place, Suite 226, Pittsburgh, PA 15213, USA
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11
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Bowman M, Vélez CA, Jericevic D, Shapiro K, Mbassa R, Fang R, Brucker BM, Van Kuiken M. Factors Influencing Medication Selection for Management of Overactive Bladder: Trends and Insights From AUA Quality Registry. Urology 2024; 184:51-57. [PMID: 38081481 DOI: 10.1016/j.urology.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To determine how a patient's demographics, including insurance type, race/ethnicity, gender, and age, may impact the choice of medication prescribed for overactive bladder (OAB). METHODS We queried the AUA Quality Registry for adults between 2014 and 2020 with a diagnosis of OAB for >1year, excluding neurogenic causes. Variables included age, race/ethnicity, gender, insurance type, medication first prescribed, year of prescription, provider metropolitan status, and provider practice type. Primary outcome was which factors were associated with increased odds of beta-3 prescription as first medication choice. RESULTS We found 1,453,566 patients with OAB, 641,122 (44.1%) with complete data. Of these, 112,021 (17.5%) were prescribed medication. On multivariate analysis, patients with Medicaid, Medicare, and other/self-pay insurance were less likely to receive a beta-3 vs an anticholinergic compared to private or military insurance. Compared to white patients, Asian, Black, and other races were less likely to receive a beta-3, as were patients outside of metropolitan areas. Age >50, prescriptions after 2014, and nonacademic settings were associated with increased odds of beta-3 prescription. There was no difference between genders. CONCLUSION Many nonclinical factors, including insurance type and race, may affect which medication is first prescribed for OAB. This is useful for practicing urologists and may help lower barriers to beta-3 prescription through policy change and advocacy.
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Affiliation(s)
- Max Bowman
- University of California San Francisco, Department of Urology, San Francisco, CA.
| | - Camille A Vélez
- Universidad Central del Caribe, School of Medicine, Bayamon, PR
| | - Dora Jericevic
- New York University Langone, Department of Urology, New York, NY
| | | | | | | | | | - Michelle Van Kuiken
- University of California San Francisco, Department of Urology, San Francisco, CA
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Ackerman AL, Torosis M, Jackson NJ, Caron AT, Kaufman MR, Lowder JL, Routh JC. The Persistency Index: a novel screening tool for identifying myofascial pelvic floor dysfunction in patients seeking care for lower urinary tract symptoms. Am J Obstet Gynecol 2023; 229:667.e1-667.e11. [PMID: 37633575 PMCID: PMC11000817 DOI: 10.1016/j.ajog.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Patients with myofascial pelvic floor dysfunction often present with lower urinary tract symptoms, such as urinary frequency, urgency, and bladder pressure. Often confused with other lower urinary tract disorders, this constellation of symptoms, recently termed myofascial urinary frequency syndrome, is distinct from other lower urinary tract symptoms and optimally responds to pelvic floor physical therapy. A detailed pelvic floor myofascial examination performed by a skilled provider is currently the only method to identify myofascial urinary frequency syndrome. Despite a high influence on quality of life, low awareness of this condition combined with no objective diagnostic testing leads to the frequent misdiagnosis or underdiagnosis of myofascial urinary frequency syndrome. OBJECTIVE This study aimed to develop a screening measure to identify patients with myofascial urinary frequency syndrome (bothersome lower urinary tract symptoms secondary to myofascial pelvic floor dysfunction) from patient-reported symptoms. STUDY DESIGN A population of patients with isolated myofascial urinary frequency syndrome was identified by provider diagnosis from a tertiary urology practice and verified by standardized pelvic floor myofascial examination and perineal surface pelvic floor electromyography. Least Angle Shrinkage and Selection Operator was used to identify candidate features from the Overactive Bladder Questionnaire, Female Genitourinary Pain Index, and Pelvic Floor Distress Index predictive of myofascial urinary frequency syndrome in a pooled population also containing subjects with overactive bladder (n=42), interstitial cystitis/bladder pain syndrome (n=51), and asymptomatic controls (n=54) (derivation cohort). A simple, summated score of the most discriminatory questions using the original scaling of the Pelvic Floor Distress Index 5 (0-4) and Genitourinary Pain Index 5 (0-5) and modified scaling of Female Genitourinary Pain Index 2b (0-3) had an area under the curve of 0.75. As myofascial urinary frequency syndrome was more prevalent in younger subjects, the inclusion of an age penalty (3 points added if under the age of 50 years) improved the area under the curve to 0.8. This score was defined as the Persistency Index (possible score of 0-15). The Youden Index was used to identify the optimal cut point Persistency Index score for maximizing sensitivity and specificity. RESULTS Using a development cohort of 215 subjects, the severity (Pelvic Floor Distress Index 5) and persistent nature (Female Genitourinary Pain Index 5) of the sensation of incomplete bladder emptying and dyspareunia (Female Genitourinary Pain Index 2b) were the most discriminatory characteristics of the myofascial urinary frequency syndrome group, which were combined with age to create the Persistency Index. The Persistency Index performed well in a validation cohort of 719 patients with various lower urinary tract symptoms, including overactive bladder (n=285), interstitial cystitis/bladder pain syndrome (n=53), myofascial urinary frequency syndrome (n=111), controls (n=209), and unknown diagnoses (n=61), exhibiting an area under the curve of 0.74. A Persistency Index score ≥7 accurately identified patients with myofascial urinary frequency syndrome from an unselected population of individuals with lower urinary tract symptoms with 80% sensitivity and 61% specificity. A combination of the Persistency Index with the previously defined Bladder Pain Composite Index and Urge Incontinence Composite Index separated a population of women seeking care for lower urinary tract symptoms into groups consistent with overactive bladder, interstitial cystitis/bladder pain syndrome, and myofascial urinary frequency syndrome phenotypes with an overall diagnostic accuracy of 82%. CONCLUSION Our study recommends a novel screening method for patients presenting with lower urinary tract symptoms to identify patients with myofascial urinary frequency syndrome. As telemedicine becomes more common, this index provides a way of screening for myofascial urinary frequency syndrome and initiating pelvic floor physical therapy even before a confirmatory pelvic examination.
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Affiliation(s)
- A Lenore Ackerman
- Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA.
| | - Michele Torosis
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Nicholas J Jackson
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Ashley T Caron
- Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Melissa R Kaufman
- Division of Reconstructive Urology and Pelvic Health, Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Jerry L Lowder
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - Jonathan C Routh
- Division of Urologic Surgery, Department of Urology, Duke University School of Medicine, Durham, NC
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Dmochowski RR, Newman DK, Rovner ES, Zillioux J, Malik RD, Ackerman AL. Patient and Clinician Challenges with Anticholinergic Step Therapy in the Treatment of Overactive Bladder: A Narrative Review. Adv Ther 2023; 40:4741-4757. [PMID: 37725308 PMCID: PMC10567877 DOI: 10.1007/s12325-023-02625-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/21/2023] [Indexed: 09/21/2023]
Abstract
Anticholinergics have been used in the treatment of overactive bladder (OAB), but their use is limited by poor tolerability and anticholinergic-related side effects. Increasingly, providers are discontinuing anticholinergic prescribing because of growing evidence of the association of anticholinergic use with increased risk of cognitive decline and other adverse effects. Newer medications for OAB, the β3-adrenergic receptor agonists mirabegron and vibegron, do not have anticholinergic properties and are typically well tolerated; however, many insurance plans have limited patient access to these newer OAB medications by requiring step therapy, meaning less expensive anticholinergic medications must be trialed and/or failed before a β3-agonist will be covered and dispensed. Thus, many patients are unable to easily access these medications. Step therapy and other drug utilization strategies (e.g., prior authorization) are often used to manage the growing costs of pharmaceuticals, but these policies do not always follow treatment guidelines and may harm patients as a result of treatment delays, discontinuations, or related increases in adverse events. Medical professionals have called for reform of drug utilization strategies through partnerships that include clinicians and policymakers. This narrative review discusses prescribing patterns for OAB treatment and the effect of switching between drugs, as well as the costs of step therapy and prior authorization on patients and prescribers.
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Affiliation(s)
- Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Jacqueline Zillioux
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rena D Malik
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - A Lenore Ackerman
- Departments of Urology and Obstetrics and Gynecology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Box 951738, Los Angeles, CA, 90095-1738, USA.
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Matta R, Saskin R, Neu S, Locke JA, Kowalczyk A, Steup A, Herschorn S. Predicting Mirabegron Treatment Response in Patients with Overactive Bladder: A Post Hoc Analysis of Data from Clinical Trials. Eur Urol Focus 2023; 9:957-965. [PMID: 37120417 DOI: 10.1016/j.euf.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/02/2023] [Accepted: 04/02/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Many patients discontinue overactive bladder (OAB) treatment because of unmet treatment expectations and/or tolerability issues. OBJECTIVE To develop a model for predicting the individual treatment response to mirabegron using patient baseline characteristics. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc analysis of data from eight global phase 2/3, double-blind, randomized, placebo- or active-controlled trials of mirabegron in adult patients with OAB. INTERVENTION Mirabegron 50 mg once-daily monotherapy for ≥12 wk. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary efficacy outcomes were the change in the mean number of micturitions and the number of incontinence episodes/24 h after 12 wk of treatment. Secondary efficacy outcomes were the change in the mean number of urgency episodes/24 h and the change in Symptom Bother score after 12 wk of treatment. Baseline demographic characteristics, OAB-related characteristics, and intrinsic and extrinsic factor variables were used to create multivariable linear regression models to predict the primary and secondary outcomes. RESULTS AND LIMITATIONS Data for 3627 patients were included. The predicted effect of mirabegron 50 mg was an average of 2.5 fewer micturition episodes/24 h (95% confidence interval -2.85 to -2.14) and 0.81 fewer incontinence episodes/24 h (95% confidence interval -1.15 to -0.46) from baseline to week 12. A higher number of urgency episodes was predictive of a larger reduction in micturition episodes; body mass index (BMI) ≥30 kg/m2, OAB symptoms for ≥12 mo, and incontinence at baseline were predictive of a smaller reduction. Mixed stress/urgency incontinence and more than five urgency episodes per day were predictive of greater reductions in incontinence episodes. Reductions in urgency episodes and Symptom Bother score were also predicted with mirabegron. Limitations include the exclusion of placebo groups from the analysis and the use of clinical trial rather than real-world data. CONCLUSIONS Data from the predictive models provide new insights into the effects of modifiable factors (such as BMI) and nonmodifiable factors on treatment outcomes with mirabegron 50 mg. PATIENT SUMMARY This study aimed to identify factors that could predict how patients with overactive bladder respond to mirabegron treatment to help doctors effectively treat this condition. Mirabegron treatment was associated with a lower number of urinations and occurrences of urinary incontinence per day. Factors associated with worse responses to the medication included being obese.
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Affiliation(s)
- Rano Matta
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Refik Saskin
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Sarah Neu
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jennifer A Locke
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | | | - Achim Steup
- Astellas Pharma US, Inc., Northbrook, IL, USA
| | - Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
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15
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Ackerman AL, Jackson NJ, Caron AT, Kaufman MR, Routh JC, Lowder JL. Myofascial urinary frequency syndrome is a novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction. Sci Rep 2023; 13:18412. [PMID: 37891217 PMCID: PMC10611808 DOI: 10.1038/s41598-023-44862-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
This study describes a novel, distinct phenotype of urinary symptoms named "myofascial urinary frequency syndrome" (MUFS) present in one-third of individuals presenting with urinary frequency. In addition to a characteristic symptom constellation suggestive of myofascial dysfunction, MUFS subjects exhibit "persistency": a persistent feeling of needing to urinate regardless of urine volume. On examination, 97% of MUFS patients demonstrated pelvic floor hypertonicity with either global tenderness or myofascial trigger points, and 92% displayed evidence of impaired muscular relaxation, hallmarks of myofascial dysfunction. To confirm this symptom pattern was attributable to the pelvic floor musculature, we confirmed the presence of "persistency" in 68 patients with pelvic floor myofascial dysfunction established through comprehensive examination and electromyography and corroborated by improvement with pelvic floor myofascial release. These symptoms distinguish subjects with myofascial dysfunction from subjects with OAB, IC/BPS, and asymptomatic controls, confirming MUFS is a distinct LUTS symptom complex.
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Affiliation(s)
- A Lenore Ackerman
- Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Box 951738, Los Angeles, CA, 90095-1738, USA.
| | - Nicholas J Jackson
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ashley T Caron
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Melissa R Kaufman
- Division of Reconstructive Urology and Pelvic Health, Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis, USA
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Bretschneider CE, Liu Q, Smith AR, Mansfield SA, Kirkali Z, Amundsen CL, Lai HH, Geynisman-Tan J, Kirby A, Jelovsek JE. Development and validation of models predicting treatment patterns in women with urinary urgency and/or urgency incontinence: A Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study. Neurourol Urodyn 2023; 42:1214-1226. [PMID: 37269483 PMCID: PMC10581676 DOI: 10.1002/nau.25222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To develop a tool to predict a woman's treatment pattern for bothersome urinary urgency (UU) and/or UU incontinence over 1 year after presenting for care at urology or urogynecology clinics. METHODS The Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study enrolled adult women with bothersome UU and/or UU incontinence using the lower urinary tract symptoms (LUTS) Tool who were seeking care for LUTS. Treatments for UU and/or urgency incontinence were ordered from least to most invasive. Ordinal logistic and Cox proportional hazard regression models were fit to predict the most invasive level of treatment during follow-up and overactive bladder (OAB) medication discontinuation, respectively. Binary logistic regression was performed to predict sling treatment during the study follow-up. Clinical tools were then created using the models listed above to predict treatment pattern over 12 months. RESULTS Among 349 women, 281 reported UU incontinence, and 68 reported UU at baseline. The highest level of treatment during the study was as follows: 20% no treatment, 24% behavioral treatments, 23% physical therapy, 26% OAB medication, 1% percutaneous tibial nerve stimulation, 3% onabotulinumtoxin A, and 3% sacral neuromodulation. Slings were placed in 10% (n = 36) of participants before baseline and in 11% (n = 40) during study follow-up. Baseline factors associated with predicting the most invasive level of treatment included baseline level of treatment, hypertension, UU incontinence severity, stress urinary incontinence (SUI) severity, and anticholinergic burden score. Less severe baseline depression and less severe UU incontinence were associated with OAB medication discontinuation. UU and SUI severity were associated with sling placement during the study period. Three tools are available to predict: (1) highest level of treatment; (2) OAB medication discontinuation; and (3) sling placement. CONCLUSIONS OAB treatment prediction tools developed in this study can help providers individualize treatment plans and identify not only patients at risk for treatment discontinuation but also patients who may not be escalated to potentially beneficial OAB treatments, with the goal to improve clinical outcomes for patients suffering from this chronic and often debilitating condition.
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Affiliation(s)
- C. Emi Bretschneider
- Northwestern University; Urogynecology and Reconstructive Surgery; Chicago IL, US
| | - Qian Liu
- Arbor Research Collaborative for Health; Ann Arbor MI, US
| | | | | | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Division of Kidney, Urologic, & Hematologic Diseases; Bethesda MD, US
| | - Cindy L. Amundsen
- Duke University; Department of Obstetrics and Gynecology, Division of Urogynecology; Durham NC, US
| | - H. Henry Lai
- Washington University in St. Louis; Division of Urologic Surgery, Departments of Surgery and Anesthesiology; St. Louis MO, US
| | - Julia Geynisman-Tan
- Northwestern University; Urogynecology and Reconstructive Surgery; Chicago IL, US
| | - Anna Kirby
- University of Washington; Obstetrics, Gynecology, & Pelvic Medicine; Seattle WA, US
| | - J. Eric Jelovsek
- Duke University; Department of Obstetrics and Gynecology, Division of Urogynecology; Durham NC, US
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Robinson D, O’Kane M, Cardozo L. Adherence to Overactive Bladder Syndrome Treatments Recent Developments and Future Perspectives. Int J Womens Health 2023; 15:799-811. [PMID: 37251090 PMCID: PMC10224686 DOI: 10.2147/ijwh.s369588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
Overactive bladder (OAB) is a common and distressing condition which is known to have a significant effect on Health-Related Quality of Life (HRQoL). Whilst all patients complaining of overactive bladder symptoms will, in theory, initially benefit from conservative measures, many will require pharmacological therapy. Antimuscarinics currently remain the most commonly used drugs to treat OAB although compliance and persistence can be poor due to concerns regarding adverse events and lack of efficacy. This review will explore the common management strategies for OAB with a particular focus on patient adherence to therapy including compliance and persistence. The role of antimuscarinics and the B3-agonist, mirabegron, will be considered along with barriers to their efficacy and adoption. For those patients in whom conservative and pharmacological treatment proves ineffective or is unsuitable, the management of refractory OAB will also be considered. In addition, the role of current and future developments will be examined.
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Affiliation(s)
- Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Miriam O’Kane
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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Hadi F, Sumarsono B, Lee KS, Oh SJ, Cho ST, Hsu YC, Rasner P, Jenkins C, Fisher H. A treatment prediction strategy for overactive bladder using a machine learning algorithm that utilized data from the FAITH study. Neurourol Urodyn 2023. [PMID: 37148497 DOI: 10.1002/nau.25190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/22/2023] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Abstract
AIMS To use machine learning algorithms to develop a model to accurately predict treatment responses to mirabegron or antimuscarinic agents in patients with overactive bladder (OAB), using real-world data from the FAITH registry (NCT03572231). METHODS The FAITH registry data included patients who had been diagnosed with OAB symptoms for at least 3 months and were due to initiate monotherapy with mirabegron or any antimuscarinic. For the development of the machine learning model, data from patients were included if they had completed the 183-day study period, had data for all timepoints and had completed the overactive bladder symptom scores (OABSS) at baseline and end of study. The primary outcome of the study was a composite outcome combining efficacy, persistence, and safety outcomes. Treatment was deemed "more effective" if the composite outcome criteria for "successful," "no treatment change," and "safe" were met, otherwise treatment was deemed "less effective." To explore the composite algorithm, a total of 14 clinical risk factors were included in the initial data set and a 10-fold cross-validation procedure was performed. A range of machine learning models were evaluated to determine the most effective algorithm. RESULTS In total, data from 396 patients were included (266 [67.2%] treated with mirabegron and 130 [32.8%] treated with an antimuscarinic). Of these, 138 (34.8%) were in the "more effective" group and 258 (65.2%) were in the "less effective" group. The groups were comparable in terms of their characteristic distributions across patient age, sex, body mass index, and Charlson Comorbidity Index. Of the six models initially selected and tested, the decision tree (C5.0) model was chosen for further optimization, and the receiver operating characteristic of the final optimized model had an area under the curve result of 0.70 (95% confidence interval: 0.54-0.85) when 15 was used for the min n parameter. CONCLUSIONS This study successfully created a simple, rapid, and easy-to-use interface that could be further refined to produce a valuable educational or clinical decision-making aid.
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Affiliation(s)
- Farid Hadi
- Astellas Pharma Medical Affairs, Singapore, Singapore
| | | | - Kyu-Sung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yu-Chao Hsu
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Paul Rasner
- Urological Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
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Dmochowski RR, Rovner ES, Kennelly MJ, Newman DK, Abedinzadeh L, Snyder D, Thomas E, Haag-Molkenteller C, Rosenberg MT. Study design of a phase 4, real-world study (COMPOSUR) to evaluate vibegron in patients with overactive bladder. BMC Urol 2023; 23:64. [PMID: 37095473 PMCID: PMC10124676 DOI: 10.1186/s12894-023-01240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Overactive bladder (OAB) is defined as urinary urgency accompanied by frequency and nocturia, with or without urge urinary incontinence (UUI). Vibegron, a selective β3-adrenergic receptor agonist approved in the US in December 2020, demonstrated efficacy in reducing symptoms of OAB and was safe and well tolerated in the 12-week EMPOWUR trial and its 40-week, double-blind extension trial. The goal of the COMPOSUR study is to evaluate vibegron in a real-world setting to assess patient treatment satisfaction, tolerability, safety, duration of treatment, and persistence. METHODS This is a 12-month, prospective, observational, real-world study, with an optional 12-month extension to 24 months, in the US assessing adults ≥ 18 years old starting a new course of vibegron. Patients must be previously diagnosed with OAB with or without UUI, symptomatic for ≥ 3 months before enrollment, and receive prior treatment with an anticholinergic, with mirabegron, or with a combination of an anticholinergic and mirabegron. Enrollment is performed by the investigator following exclusion and inclusion criteria guided by US product labeling, reinforcing a real-world approach. Patients complete the OAB Satisfaction with Treatment Questionnaire (OAB-SAT-q) monthly and the OAB Questionnaire short form (OAB-q-SF) and Work Productivity and Activity Impairment Questionnaire (WPAI:US) at baseline and monthly for 12 months. Patients are followed up via phone call, in-person visits, or telehealth (ie, virtual) visits. The primary endpoint is patient treatment satisfaction as determined by the OAB-SAT-q satisfaction domain score. Secondary endpoints include percent positive responses to individual OAB-SAT-q questions, additional OAB-SAT-q domain scores, and safety. Exploratory endpoints include adherence and persistence. DISCUSSION OAB leads to a significant decrease in quality of life, as well as impairment of work activities and productivity. Persistence with OAB treatments can be challenging, often due to lack of efficacy and adverse effects. COMPOSUR is the first study to provide long-term, prospective, pragmatic treatment data for vibegron in the US and the resultant effect on quality of life among patients with OAB in a real-world clinical setting. Trial registration ClinicalTrials.gov identifier: NCT05067478; registered: October 5, 2021.
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Affiliation(s)
- Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Ackerman AL, Jackson NJ, Caron AT, Kaufman MR, Routh JC, Lowder JL. Myofascial Frequency Syndrome: A novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.14.23288590. [PMID: 37131628 PMCID: PMC10153318 DOI: 10.1101/2023.04.14.23288590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Patients presenting with lower urinary tract symptoms (LUTS) are historically classified to several symptom clusters, primarily overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS). Accurate diagnosis, however, is challenging due to overlapping symptomatic features, and many patients do not readily fit into these categories. To enhance diagnostic accuracy, we previously described an algorithm differentiating OAB from IC/BPS. Herein, we sought to validate the utility of this algorithm for identifying and classifying a real-world population of individuals presenting with OAB and IC/BPS and characterize patient subgroups outside the traditional LUTS diagnostic paradigm. Methods An Exploratory cohort of 551 consecutive female subjects with LUTS evaluated in 2017 were administered 5 validated genitourinary symptom questionnaires. Application of the LUTS diagnostic algorithm classified subjects into controls, IC/BPS, and OAB, with identification of a novel group of highly bothered subjects lacking pain or incontinence. Symptomatic features of this group were characterized by statistically significant differences from the OAB, IC/BPS and control groups on questionnaires, comprehensive review of discriminate pelvic exam, and thematic analysis of patient histories. In a Reassessment cohort of 215 subjects with known etiologies of their symptoms (OAB, IC/BPS, asymptomatic microscopic hematuria, or myofascial dysfunction confirmed with electromyography), significant associations with myofascial dysfunction were identified in a multivariable regression model. Pre-referral and specialist diagnoses for subjects with myofascial dysfunction were catalogued. Findings Application of a diagnostic algorithm to an unselected group of 551subjects presenting for urologic care identified OAB and IC/BPS in 137 and 96 subjects, respectively. An additional 110 patients (20%) with bothersome urinary symptoms lacked either bladder pain or urgency characteristic of IC/BPS and OAB, respectively. In addition to urinary frequency, this population exhibited a distinctive symptom constellation suggestive of myofascial dysfunction characterized as "persistency": bothersome urinary frequency resulting from bladder discomfort/pelvic pressure conveying a sensation of bladder fullness and a desire to urinate. On examination, 97% of persistency patients demonstrated pelvic floor hypertonicity with either global tenderness or myofascial trigger points, and 92% displayed evidence of impaired muscular relaxation, hallmarks of myofascial dysfunction. We therefore classified this symptom complex "myofascial frequency syndrome". To confirm this symptom pattern was attributable to the pelvic floor, we confirmed the presence of "persistency" in 68 patients established to have pelvic floor myofascial dysfunction through comprehensive evaluation corroborated by symptom improvement with pelvic floor myofascial release. These symptoms distinguish subjects with myofascial dysfunction from subjects with OAB, IC/BPS, and asymptomatic controls, confirming that myofascial frequency syndrome is a distinct LUTS symptom complex. Interpretation This study describes a novel, distinct phenotype of LUTS we classified as myofascial frequency syndrome in approximately one-third of individuals with urinary frequency. Common symptomatic features encompass elements in other urinary syndromes, such as bladder discomfort, urinary frequency and urge, pelvic pressure, and a sensation of incomplete emptying, causing significant diagnostic confusion for providers. Inadequate recognition of myofascial frequency syndrome may partially explain suboptimal overall treatment outcomes for women with LUTS. Recognition of the distinct symptom features of MFS (persistency) should prompt referral to pelvic floor physical therapy. To improve our understanding and management of this as-yet understudied condition, future studies will need to develop consensus diagnostic criteria and objective tools to assess pelvic floor muscle fitness, ultimately leading to corresponding diagnostic codes. Funding This work was supported by the AUGS/Duke UrogynCREST Program (R25HD094667 (NICHD)) and by NIDDK K08 DK118176 and Department of Defense PRMRP PR200027, and NIA R03 AG067993.
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Affiliation(s)
- A. Lenore Ackerman
- Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Nicholas J. Jackson
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Ashley T. Caron
- Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Melissa R. Kaufman
- Division of Reconstructive Urology and Pelvic Health, Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan C. Routh
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC
| | - Jerry L. Lowder
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis
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He W, Zhang Y, Huang G, Tian Y, Sun Q, Liu X. Efficacy and safety of vibegron compared with mirabegron for overactive bladder: A systematic review and network meta-analysis. Low Urin Tract Symptoms 2023; 15:80-88. [PMID: 36863312 DOI: 10.1111/luts.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/10/2022] [Accepted: 02/05/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES The aim of this study was to indirectly compare the efficacy and safety of mirabegron and vibegron in patients with overactive bladder. METHODS A systematic search was performed on Pubmed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials databases to identify studies from the date of database inception to January 1, 2022. All randomized controlled trials comparing mirabegron or vibegron with tolterodine, imidafenacin, or placebo were eligible. One reviewer extracted data, and a second reviewer checked. Included trials were assessed for similarity, and networks were developed using Stata 16.0 software. Mean differences for continuous variables and odds ratios for dichotomous variables together with their 95% confidence intervals (CIs) were used to rank treatments and compare the differences, respectively. RESULTS A total of 11 randomized controlled trials and 10 806 patients were included. For each outcome, results for all licensed treatment doses were included. Both vibegron and mirabegron were more efficacious than placebo at reducing the frequency of micturition, incontinence, urgency, urgency incontinence, and nocturia. Vibegron was more efficacious than mirabegron in reducing mean voided volume/micturition (95% CI [5.15, 14.98]). Safety outcomes for vibegron and mirabegron were similar to those in the placebo group, except for mirabegron, which had a higher risk of nasopharyngitis and cardiovascular adverse events than placebo. CONCLUSIONS Both drugs seem to be comparable and well tolerated, particularly as direct comparisons are not available. However, vibegron may be more effective than mirabegron in reducing mean voided volume.
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Affiliation(s)
- Wenjuan He
- Department of Pharmacy, The Second Hospital of HeBei Medical University, Shijiazhuang, China
| | - Yuqian Zhang
- Department of Pharmacy, The Second Hospital of HeBei Medical University, Shijiazhuang, China
| | - Guangliang Huang
- Department of Clinical Pharmacy, HeBei Medical University, Shijiazhuang, China
| | - Yunfei Tian
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Qian Sun
- Department of Pharmacy, The Second Hospital of HeBei Medical University, Shijiazhuang, China
| | - Xiuju Liu
- Department of Pharmacy, The Second Hospital of HeBei Medical University, Shijiazhuang, China
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Bryophyllum pinnatum and Improvement of Nocturia and Sleep Quality in Women: A Multicentre, Nonrandomised Prospective Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:2115335. [PMID: 36798727 PMCID: PMC9928503 DOI: 10.1155/2023/2115335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 02/10/2023]
Abstract
Nocturia is a pathologic condition that significantly affects the quality of sleep. The aetiology of nocturia is multifactorial, and the evidence available on its management remains limited. Besides behavioural measures, validated pharmaceutical treatment options exist but are, however, associated with marked side effects. Prospective clinical studies with tablets prepared from the leaf press juice of the plant Bryophyllum pinnatum revealed a tendency towards reduction of micturition in patients with overactive bladder (OAB) and several improvements in sleep quality. These observations are in part supported by in vitro and in vivo data. In the present study, we investigated the effectiveness of Bryophyllum 50% chewable tablets in the treatment of nocturia and associated sleep disorders. Altogether, 49 women with idiopathic OAB and nocturia of ≥2 voids/night were treated with Bryophyllum 50% tablets for 3 weeks (350 mg chewable tablets, dosage 0-0-2-2 oral tablets; WELEDA AG, Arlesheim, Switzerland). Nocturia, voiding volumes at night (ml), quality of life, sleep quality, and daily sleepiness were assessed before and after treatment with a 3-day micturition diary, the International Consultation on Incontinence evaluating overactive bladder and related impact on quality of life (QoL) [ICIQ-OAB], the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS), respectively. The age of the study population was 68.5 ± 11.6 y. After treatment, nocturia diminished from 3.2 ± 1.4 to 2.3 ± 1.3 (P < 0.001) and the PSQI score decreased from 7.7 ± 3.7 to 6.6 ± 3.4 (P=0.004). Urgency, the ICIQ score, and the ESS lowered significantly, and the micturition volume showed a tendency to increase. No serious adverse drug reactions were reported, and compliance was good. The results show a beneficial effect on the nocturnal voids and sleep quality of women with OAB. Bryophyllum 50% tablets can be regarded as a well-tolerated alternative in the treatment of nocturia and broaden the repertoire of standard management.
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An Analysis of Stated Insurance Coverage and Estimated Patient-Incurred Costs of Treatments for Lower Urinary Tract Symptoms. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:287-294. [PMID: 36735446 DOI: 10.1097/spv.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE Lower urinary tract symptoms (LUTSs) affect more than half of all adults, yet clinical care remains poor. Anecdotally, patients and health care providers express frustration over obstacles from insurance providers to obtaining LUTS treatment; however, little information concerning actual patient-incurred costs for these medications is available. OBJECTIVES This study aimed to analyze coverage by 5 major insurance companies and patient costs for LUTS pharmacotherapy. STUDY DESIGN For each of 5 major nationwide insurance providers (Aetna, Blue Cross/Blue Shield, Cigna, Humana, United HealthCare), formulary coverage of medications for overactive bladder, interstitial cystitis/bladder pain syndrome, and genitourinary syndrome of menopause were reviewed for low- and high-cost plans. When not covered, the best preinsurance cash price of medications was determined from GoodRx. RESULTS This qualitative analysis demonstrates that no guideline-directed therapy was universally covered by all insurance providers at low cost, regardless of the availability of generic alternatives. Medication prices ranged from $3 to $900 per month across plans. Inconsistencies in coverage and medication prices were common across insurance providers, between similar medications used for treatment of a given condition, and between a provider's low- and high-cost plans. CONCLUSIONS Even medications that are U.S. Food and Drug Administration-approved and indicated by guidelines can have patient costs that are prohibitive. Because lack of care for LUTSs profoundly affects quality of life, the ability to live independently, and overall morbidity, improved price transparency is required to understand the health implications of limited coverage on LUTS care.
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Patients' Preferences and Expectations in Overactive Bladder: A Systematic Review. J Clin Med 2023; 12:jcm12020396. [PMID: 36675324 PMCID: PMC9864850 DOI: 10.3390/jcm12020396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
The aim of our study is to review the current available knowledge regarding preferences and expectations of patients with overactive bladder (OAB). The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines were followed for this manuscript's preparation. Three online databases were searched: PubMed/Medline, Embase, and Scopus, while a combination of the following keywords was used: detrusor overactivity, overactive bladder, urinary incontinence, perspectives, expectations, and preferences. Overall, 1349 studies were retrieved and screened while only 10 studies appeared to be relevant for the scope of this review. Most of the studies were related to preferences about OAB medications (i.e., antimuscarinics); four of them reported patients' inclinations to alternative treatments in the case of medication therapy failure (i.e., neuromodulation, Botox). No data were found about diagnosis or other aspects of disease management (i.e., surgery, follow-up). Based on these findings, from the patient's point of view, the ideal medication should be cheap, without risk of cognitive function impairment, and able to reduce daytime urinary frequency and incontinence episodes.
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Efficacy and Safety of Vibegron for the Treatment of Overactive Bladder in Women: A Subgroup Analysis From the Double-Blind, Randomized, Controlled EMPOWUR Trial. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:48-57. [PMID: 36384907 DOI: 10.1097/spv.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE The international phase 3 EMPOWUR trial demonstrated efficacy and safety of vibegron, a newer β 3 -adrenergic receptor agonist, in adults with overactive bladder (OAB). Women are disproportionately affected by OAB, especially those with bothersome symptoms, such as urge urinary incontinence (UUI). OBJECTIVE This subgroup analysis from EMPOWUR assessed efficacy and safety of vibegron in women. STUDY DESIGN In EMPOWUR, patients with OAB were randomized 5:5:4 to 12 weeks of treatment with once-daily vibegron 75 mg, placebo, or tolterodine 4-mg extended release. Efficacy end points included change from baseline at week 12 in mean daily number of micturitions, UUI episodes, and urgency episodes. Safety was assessed through adverse events (AEs). RESULTS Of the patients included in the analysis, 1286 (84.9%) were women (vibegron, n = 463; placebo, n = 459; tolterodine, n = 364). At week 12, women receiving vibegron showed significant reductions (95% confidence intervals of least squares mean differences does not include 0) from baseline versus placebo in mean daily micturitions, UUI episodes, and urgency episodes, with least squares mean differences (95% confidence intervals) of -0.5 (-0.8 to -0.2), -0.7 (-1.0 to -0.4), and -0.8 (-1.3 to -0.4), respectively. Treatment-emergent AE incidence was similar with vibegron (39%) and placebo (35%); the most common AE with incidence higher with vibegron (4.3%) than placebo (2.6%) was headache. CONCLUSIONS In this subgroup analysis, women receiving vibegron showed significant reductions in key efficacy end points versus placebo and favorable safety profile, consistent with the overall results from EMPOWUR, suggesting that vibegron is efficacious and safe for the treatment of OAB in this patient population.
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Bretschneider CE, Liu Q, Smith AR, Kirkali Z, Amundsen CL, Lai HH, Geynisman-Tan J, Kirby A, Cameron AP, Helmuth ME, Griffith JW, Jelovsek JE. Treatment patterns in women with urinary urgency and/or urgency urinary incontinence in the symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study. Neurourol Urodyn 2023; 42:194-204. [PMID: 36579974 PMCID: PMC9811511 DOI: 10.1002/nau.25067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Limited epidemiological data exist describing how patients engage with various treatments for overactive bladder (OAB). To improve care for patients with OAB, it is essential to gain a better understanding of how patients interface with OAB treatments longitudinally, that is, how often patients change treatments and the pattern of this treatment change in terms of escalation and de-escalation. OBJECTIVES To describe treatment patterns for women with bothersome urinary urgency (UU) and/or urgency urinary incontinence (UUI) presenting to specialty care over 1 year. STUDY DESIGN The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study enrolled adult women with bothersome UU and/or UUI seeking care for lower urinary tract symptoms (LUTS) between January 2015 and September 2016. An ordinal logistic regression model was fitted to describe the probabilities of escalating or de-escalating level of treatment during 1-year follow-up. RESULTS Among 349 women, 281 reported UUI and 68 reported UU at baseline. At the end of 1 year of treatment by a urologist or urogynecologist, the highest level of treatment received by participants was 5% expectant management, 36% behavioral treatments (BT), 26% physical therapy (PT), 26% OAB medications, 1% percutaneous tibial nerve stimulation, 3% intradetrusor onabotulinum toxin A injection, and 3% sacral neuromodulation. Participants using BT or PT at baseline were more likely to be de-escalated to no treatment than participants on OAB medications at baseline, who tended to stay on medications. Predictors of the highest level of treatment included starting level of treatment, hypertension, UUI severity, stress urinary incontinence, and anticholinergic burden score. CONCLUSIONS Treatment patterns for UU and UUI are diverse. Even for patients with significant bother from OAB presenting to specialty clinics, further treatment often only involves conservative or medical therapies. This study highlights the need for improved treatment algorithms to escalate patients with persistent symptoms, or to adjust care in those who have been unsuccessfully treated.
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Affiliation(s)
| | - Q. Liu
- Arbor Research Collaborative for Health, Ann Arbor, MI USA
| | | | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD USA
| | | | - H. Henry Lai
- Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Anna Kirby
- University of Washington Medical Center, Seattle, WA, USA
| | | | | | - James W. Griffith
- Northwestern University – The Feinberg School of Medicine, Chicago, IL, USA
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Fan B, Shen J, Wu L, Zhang P. Study of mirabegron and solifenacin in the improvement of catheter-related bladder discomfort in patients undergoing transurethral resection: A case-control study. Medicine (Baltimore) 2022; 101:e32052. [PMID: 36482620 PMCID: PMC9726409 DOI: 10.1097/md.0000000000032052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The goal of this study was to see if using mirabegron, solifenacin, or placebo may help patients with transurethral resection avoid catheter-related bladder discomfort (CRBD). METHODS Patients who underwent transurethral surgery and were given a catheter for 3 days after surgery were chosen for this study. The enrolled patients were separated into 3 groups: mirabegron (M), solifenacin (S), and a blank control group (C). All patients had their overactive bladder symptoms score (OABSS) and blood pressure checked before surgery. The CRBD, blood pressure, and heart rate were measured at 6, 24, 48, and 72 hours after surgery. The OABSS and side effects were documented on the 7th day. RESULTS The 104 patients in this trial were randomized into 3 groups at random: M, S, and C. The ultimate follow-up was completed by 99 patients, including 33 in group M, 33 in group S, and 33 in group C. The OABSS, CRBD, and blood pressure in groups M and S were similar before and after surgery (P > .05). Groups M and S performed much better on the OABSS and CRBD than group C (P < .05). There were no significant differences in blood pressure between the 3 groups (P > .05). There were no significant differences in the occurrences of new onset dry mouth (P = .84) or constipation (P = .64) among the 3 groups. CONCLUSION Mirabegron is comparable to solifenacin as an alternative for the prevention of CRBD, making it a viable option for CRBD prevention.
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Affiliation(s)
- Bohan Fan
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jianwu Shen
- Urology Department of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Liyang Wu
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Peng Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
- * Correspondence: Peng Zhang, Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing 100020, China (e-mail: )
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Duperrouzel C, Martin C, Mendell A, Bourque M, Carrera A, Mack A, Nesheim J. Healthcare and economic burden of anticholinergic use in adults with overactive bladder: a systematic literature review. J Comp Eff Res 2022; 11:1375-1394. [PMID: 36354285 DOI: 10.2217/cer-2022-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: To determine the economic burden associated with anticholinergic medication use in adults with overactive bladder (OAB) in the USA. Methods: A systematic literature review was conducted to identify articles assessing healthcare resource utilization (HCRU) and costs associated with anticholinergic use in adults with OAB. Results: From the 34 articles identified, increased anticholinergic burden, switching anticholinergic treatments and potentially inappropriate anticholinergic use were associated with increased HCRU and/or costs. However, studies comparing patients with OAB receiving anticholinergics to individuals with untreated OAB or without OAB reported a mix of increases and decreases in HCRU and costs. Conclusion: Additional controlled studies assessing the economic impact of anticholinergics in OAB are needed and may enable optimization of economic and potentially patient outcomes.
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Kennelly M, Wielage R, Shortino D, Thomas E, Mudd PN. Long-term efficacy and safety of vibegron versus mirabegron and anticholinergics for overactive bladder: a systematic review and network meta-analysis. Drugs Context 2022; 11:dic-2022-4-2. [PMID: 36303599 PMCID: PMC9576010 DOI: 10.7573/dic.2022-4-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022] Open
Abstract
Background Few randomized controlled trials evaluate the long-term efficacy and safety of pharmacotherapy for overactive bladder (OAB). This network meta- analysis compares the long-term (52-week) efficacy and safety of vibegron, mirabegron and anticholinergics for the treatment of OAB. Methods A systematic literature review and network meta-analysis were conducted following PRISMA guidelines using MEDLINE, Embase and Cochrane Central Register of Controlled Trials and terms related to OAB. Efficacy outcomes included change from baseline to week 48–52 in mean daily total urinary incontinence (UI) episodes, mean daily number of micturitions and volume voided/micturition. Efficacy outcomes were analysed using Bayesian models. Commonly reported adverse events (AEs) are described. Results Of 2098 hits retrieved, 5 publications and 1 study report describing 5 unique randomized controlled trials were included in the analyses. Mean (95% credible interval) change from baseline in total UI episodes for vibegron 75 mg (−2.2; −2.9 to −1.5) showed a significantly greater reduction than mirabegron 50 mg (−1.3; −1.9 to −0.8) and tolterodine 4 mg extended release (−1.6; −2.1 to −1.1). No significant differences were observed between vibegron and comparators for daily micturitions or volume voided/micturition. Within the manuscripts, the 4 most common AEs (range) for anticholinergics included dry mouth (5.2–90.0%), constipation (7.7–65.0%), blurred vision (3.8–35.0%) and hypertension (8.6–9.6%); the 4 most commonly reported AEs for β3-adrenergic agonists included hypertension (8.8–9.2%), urinary tract infection (5.9–6.6%), headache (5.5%) and nasopharyngitis (4.8–5.2%). Conclusion Vibegron was associated with significantly greater improvement in daily total UI episodes at 52 weeks than mirabegron and tolterodine. When reported, the most common AE for anticholinergics was dry mouth and for β3-adrenergic agonists was hypertension. Hypertension incidence was similar between drug classes.
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Kitta T, Chiba H, Kon M, Higuchi M, Kusakabe N, Ouchi M, Togo M, Abe-Takahashi Y, Tsukiyama M, Shinohara N. Urodynamic evaluation of the efficacy of vibegron, a new β3-adrenergic receptor agonist, on lower urinary tract function in children and adolescents with overactive bladder. J Pediatr Urol 2022; 18:563-569. [PMID: 35965225 DOI: 10.1016/j.jpurol.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Idiopathic overactive bladder (OAB) is defined as an urgency symptom with or without urge incontinence, which is not due to known neurological abnormalities. Since children present with variable symptoms, pediatric nonneurogenic idiopathic OAB is a condition that is difficult to diagnose and treat. Although there are few reports on bladder function in pediatric patients compared to adult patients, it can be useful for diagnosis. Antimuscarinic therapy is the pharmacological mainstay of OAB management. However, antimuscarinic use is limited by side effects and Insufficient effects. Vibegron, a new drug with a different mechanism of action (β3-adrenoreceptor agonist), was recently introduced for treating OAB in adults but has not been studied in the pediatric population. OBJECTIVE This study aimed to determine the efficacy and tolerability of vibegron in children and adolescents with idiopathic OAB. STUDY DESIGN We conducted a retrospective study enrolling pediatric patients with OAB whose symptoms did not improve with behavioral therapy or pharmaceutical therapy. Efficacy and tolerability were assessed via a question, and patients underwent video-urodynamic testing before and during treatment with once-daily 50 mg vibegron. Statistical differences were evaluated using Wilcoxon matched-pairs signed-rank tests. RESULTS Out of the 17 patients that were recruited, full study with two urodynamic studies were confirmed by 11 patients. OAB symptoms improved in 14 (82.4%) patients, and 3 patients discontinued treatment because of ineffectiveness. No patients discontinued treatment because of intolerance to vibegron. The median (IQR) first desire to void (133 [82-185]-161 [123-227] mL), bladder capacity (158 [136-238]-204 [150-257] mL), and bladder compliance (18.1 [9.1-76.7]-34.0 [30.0-82.3] mL/cm H2O) improved significantly post treatment compared to before treatment. Detrusor overactivity disappeared in one of the eight patients with this condition. The parameters of voiding function did not change significantly after the administration of vibegron. DISCUSSION Treatment with vibegron significantly improved clinical and urodynamic parameters of pediatric OAB with no adverse effects. Little information is available regarding the feasibility of switching drugs when patients discontinue prior pharmacological therapy because of insufficient efficacy or poor tolerability in children. Vibegron may be a promising OAB treatment option with a better balance of efficacy and tolerability. CONCLUSIONS Vibegron is an alternative agent for pediatric patients with idiopathic OAB for improving both subjective symptoms and lower urinary tract function. Future prospective randomized studies with larger sample sizes must be conducted to validate the results of the present study.
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Affiliation(s)
- Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naohisa Kusakabe
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mifuka Ouchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mio Togo
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yui Abe-Takahashi
- Department of Physical Therapy, Faculty of Health Sciences Hokkaido University of Science, Sapporo, Japan
| | - Mayuko Tsukiyama
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Gleicher S, Sebesta EM, Reynolds WS, Dmochowski R. Vibegron for the treatment of overactive bladder: a comprehensive update. Expert Opin Pharmacother 2022; 23:1479-1484. [PMID: 36124780 DOI: 10.1080/14656566.2022.2126311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Overactive bladder (OAB) is associated with physical, emotional and financial burden. After failed conservative measures, second-line therapy includes medications, such as antimuscarinics and beta-3 adrenergic receptor (β3AR) agonists. Antimuscarinics are most commonly prescribed but have systemic side effects that lead to poor compliance. β3AR agonists include mirabegron and vibegron. Mirabegron is a first generation β3AR agonist that has shown to be effective for frequency, urgency urinary incontinence (UUI) and urgency, but has interactions with cytochrome P450 enzymes (CYPs) and cardiovascular sequelae. Vibegron is a second generation β3AR agonist that is highly selective and does not interact with CYPs. It has shown to be very effective for reducing UUI episodes and daily micturition number and has a favorable side effect profile. AREAS COVERED : Clinical background, pharmacology, and clinical studies for vibegron.Expert opinion: Vibegron is a welcomed addition to the OAB therapeutic landscape. This single dose, once daily option is effective, especially for patients with wet OAB, with a favorable side effect profile. Sub-analyses of patients ≥ 65 years have shown continued efficacy and safety. The few drug interactions are of benefit, especially for older patients with polypharmacy. As long-term data accrues, vibegron has the potential to drive the OAB therapeutic market.
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Affiliation(s)
- Stephanie Gleicher
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elisabeth M Sebesta
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Davidson ER, Miceli L, Propst K. Why Patients Fall Through the Cracks: Assessment of Patients' Overactive Bladder Treatment. J Womens Health (Larchmt) 2022; 31:1314-1319. [PMID: 35363051 PMCID: PMC9527055 DOI: 10.1089/jwh.2021.0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Despite an established treatment algorithm for overactive bladder (OAB), it is unclear how many patients proceed through each step. Our objective was to evaluate the percentage of patients receiving each step of care and identify reasons why patients did not receive certain treatments. Methods: This was a retrospective cohort study with cross-sectional survey of new OAB patients. The medical record was queried for relevant patient characteristics and documentation of conservative, medical, and third-line therapies. In the survey, patients were asked about current bladder symptoms and reasons why they did not use certain treatments. Descriptive statistics were used for analysis. Results: One hundred eleven patients met the inclusion criteria; the most common diagnosis was mixed incontinence (40%, n = 45). The median number of visits for OAB was 2 (range 1-8). On retrospective analysis, 64% (71) of patients had documented attempts at conservative therapy. Seventy-six percent (84) of patients attempted medical therapy, and only 11% (12) progressed to any third-line therapy. Fifty-nine percent (64) of eligible patients responded to the survey. Fifty-three percent (34) of respondents reported persistent moderate to very severe bother due to bladder symptoms. Thirty percent to fifty percent of patients who did not attempt one or more of the three levels of OAB therapy reported that they were never offered that treatment option. Conclusions: Many patients do not progress to the next steps in OAB therapy despite failure of more conservative treatments. Barriers to care included limited follow-up and education about other therapy options. A formalized institutional care pathway may lead to improved OAB treatment.
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Affiliation(s)
- Emily R.W. Davidson
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lia Miceli
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Katie Propst
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Staskin D. Clinical direction in the pharmacological and device management of refractory overactive bladder: the urge to develop new treatments. Expert Opin Pharmacother 2022; 23:1475-1477. [PMID: 36045592 DOI: 10.1080/14656566.2022.2117609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- David Staskin
- Division of Urology, St. Elizabeth's Medical Center, Steward Health, Tufts University School of Medicine, Boston, MA, USA
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Rahman-Yildir J, Wiedey R, Breitkreutz J. Dissolution studies of 3D-printed inserts in a novel biopharmaceutical bladder model. Int J Pharm 2022; 624:121984. [DOI: 10.1016/j.ijpharm.2022.121984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/21/2022] [Accepted: 07/02/2022] [Indexed: 11/24/2022]
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Müderrisoglu AE, Oelke M, Schneider T, Murgas S, de la Rosette JJMCH, Michel MC. What Are Realistic Expectations to Become Free of Overactive Bladder Symptoms? Experience from Non-interventional Studies with Propiverine. Adv Ther 2022; 39:2489-2501. [PMID: 35325367 PMCID: PMC9123021 DOI: 10.1007/s12325-022-02114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Unmet expectations are a major cause of perceived treatment failure and discontinuation of treatment. To enable evidence-based counselling of patients on realistic expectations, we determined the chance of patients with overactive bladder becoming free of a given symptom upon treatment with a muscarinic antagonist in a non-interventional setting. METHODS Two non-interventional studies included 1335 and 745 patients, respectively, who received 30 or 45 mg q.d. propiverine ER for 12 weeks. They were monitored for becoming free of urgency, urinary incontinence, frequency, or nocturia. Analyses were also performed in subgroups defined by basal symptom severity, age, and gender. Categorical data are shown as a percentage of the respective population. Continuous data are expressed as means or as median depending on whether the variability was considered to exhibit a normal distribution. RESULTS The probability of becoming symptom-free was largest for incontinence and frequency (about 50%), but lesser for urgency (about 20%) and nocturia (about 10%). Greater basal severity of a symptom reduced the chance to become free of that symptom upon treatment, but the chance to become free of incontinence and frequency was still considerable. Age and gender had only minor if any effects on the chance of becoming symptom-free. These findings are in line with those of a limited number of randomized controlled trials. CONCLUSION These data provide an evidence base for the counselling of patients with overactive bladder on realistic expectations of treatment outcomes. We propose that realistic expectations can lead to greater long-term adherence.
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Affiliation(s)
- A Elif Müderrisoglu
- Department of Medical Pharmacology, Istanbul Medipol University, Istanbul, Turkey
| | - Matthias Oelke
- Department of Urology, St. Antonius-Hospital, Gronau, Germany
| | - Tim Schneider
- Clinic for Urology Rhein Ruhr (PUR/R), Mülheim, Germany
| | | | | | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
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Rahman-Yildir J, Fischer B, Breitkreutz J. Development of sustained-release drug-loaded intravesical inserts via semi-solid micro-extrusion 3D-printing for bladder targeting. Int J Pharm 2022; 622:121849. [PMID: 35618176 DOI: 10.1016/j.ijpharm.2022.121849] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/31/2022]
Abstract
Discontinued treatment and non-adherence are oftentimes weaknesses of common first-line drug therapy against bladder conditions due to their negative side-effects. To overcome these limitations and increase patients' quality of life, intravesical therapies are continuously being explored. 3D-printing offers the possibility of freely tailoring drug delivery systems to manufacture indwelling devices that may administer drugs locally over an extended time and avoiding frequently repeated administrations while minimizing systemic side-effects. In the present work, pressure-assisted micro syringe printing has been used to develop flexible drug-loaded inserts applicable via common urinary catheter that can remain up to several weeks inside the urinary bladder. Three APIs (lidocaine hydrochloride, trospium chloride (TrCl) and hydrochlorothiazide (HCT)) with different properties and solubilities were investigated for their applicability together with two different pharmaceutical polymers (biodegradable polycaprolactone (PCL) and non-degradable ethylene vinyl acetate copolymer (EVA)). The fastest release was thereby observed for the PCL-TrCl combination and the slowest for EVA-HCT depending on the API's solubility in the dissolution medium and formation of API clusters within the matrix. It was further demonstrated that the dissolution profile could be modified by adapting drug loads between 5 and 15 % or the geometry of the printed inserts indicating the possibility of tailoring release profiles.
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Affiliation(s)
- Jhinuk Rahman-Yildir
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany; Drug Delivery Innovation Center (DDIC), INVITE GmbH, Chempark Building W 32, 51368 Leverkusen, Germany
| | - Björn Fischer
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany; FISCHER GmbH, Raman Spectroscopic Services, 40667 Meerbusch, Germany
| | - Jörg Breitkreutz
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany.
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Sheng Y, Zhang S, Ling J, Hu C, Zhang Z, Lv H. Oxybutynin nanosuspension gel for enhanced transdermal treatment for overactive bladder syndrome. Pharm Dev Technol 2022; 27:459-468. [DOI: 10.1080/10837450.2022.2078983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yuze Sheng
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
| | - Shuang Zhang
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
| | - Jiawei Ling
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
| | - Chenlu Hu
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
| | - Zhenhai Zhang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 210023, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, 210028, Nanjing, China
| | - Huixia Lv
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
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Clearwater W, Kassam F, Aalami Harandi A, Tenggardjaja CF, Abraham N. Combination and Novel Pharmacologic Agents for OAB. Curr Urol Rep 2022; 23:129-141. [PMID: 35567657 DOI: 10.1007/s11934-022-01097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To evaluate recent literature on combination and novel pharmacologic therapies for overactive bladder (OAB). RECENT FINDINGS Combination therapies demonstrating greater efficacy than monotherapy include combination anticholinergics, anticholinergic plus β-3 agonist, and anticholinergic with behavioral modification, percutaneous tibial nerve stimulation, or sacral neuromodulation. Promising novel therapies include new bladder selective anticholinergics, new β-3 agonists, and gabapentin. OAB is a symptom complex caused by dysfunction in the interconnected neural, muscular, and urothelial systems that control micturition. Although several therapeutic targets and treatment options exist, complete resolution is not always achieved, discontinuation rate for medical therapy is high, and few patients subsequently progress to third-line treatment options. Recent literature suggests combination therapy diversifying therapeutic targets is more effective than targeting a single pathway and novel treatments targeting additional pathways have promising results.
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Affiliation(s)
- Whitney Clearwater
- Department of Obstetrics & Gynecology and Women's Health, Division of Female Pelvic Medicine and Reconstructive Surgery, Montefiore Medical Center / Albert Einstein College of Medicine, 1250 Waters Place, Tower Two, 9th floor, Bronx, NY, 10461, USA
| | - Farzaan Kassam
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Tower 1 PH, Bronx, NY, 10461, USA
| | | | - Christopher F Tenggardjaja
- Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Kaiser Permanente Los Angeles Medical Center, Sunset Blvd, Los Angeles, CA, USA
| | - Nitya Abraham
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Tower 1 PH, Bronx, NY, 10461, USA.
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Soda T, Koike S, Ikeuchi R, Okada T. Utilization rate and long-term persistence of combination pharmacotherapy with β3-agonists and antimuscarinics for overactive bladder refractory to monotherapy in a real-world setting. Neurourol Urodyn 2022; 41:1165-1171. [PMID: 35419862 DOI: 10.1002/nau.24935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/24/2022] [Accepted: 04/05/2022] [Indexed: 11/07/2022]
Abstract
AIM To assess real-world treatment profiles, including utilization rate, time to and reasons for discontinuation of combination pharmacotherapy with β3 -agonists and antimuscarinics for refractory overactive bladder (OAB) through a retrospective chart review. METHODS We retrospectively reviewed the records of OAB patients who received β3 -agonists or antimuscarinics at our hospital between 2012 and 2020 and analyzed the clinical course of patients who progressed to combination therapy. Data on age, sex, major complaints, OAB symptom score at the initiation of combination therapy, treatment persistence, and reasons for discontinuation were collected. Treatment persistence was assessed with respect to the median time to discontinuation and persistence rate at 12 months. RESULTS Of the 2163 patients receiving β3 -agonists or antimuscarinics, only 84 (3.8%) progressed to combination therapy with both drug classes. At therapy initiation, most (98%) of these patients had moderate to severe OAB symptoms. Median treatment duration and 12-month persistence rate for combination therapy were 595 days and 64.0%, respectively. The reasons for discontinuation were insufficient treatment efficacy followed by adverse effects including voiding impairment in nearly 10% of the patients. None of the baseline parameters was independently associated with persistence in the multivariate analysis. CONCLUSION While underutilized among OAB patients refractory to monotherapy, combination pharmacotherapy showed a greater persistence rate than published mirabegron or antimuscarinic monotherapy when applied to patients with moderate to severe symptoms. Treatment-emergent voiding impairment is a concern associated with this mode of therapy. A small sample size at a single institution is the limitation of this study.
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Affiliation(s)
- Takeshi Soda
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Shuhei Koike
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Ryosuke Ikeuchi
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Takuya Okada
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
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Frankel J, Staskin D, Varano S, Kennelly MJ, Jankowich RA, Haag-Molkenteller C. An Evaluation of the Efficacy and Safety of Vibegron in the Treatment of Overactive Bladder. Ther Clin Risk Manag 2022; 18:171-182. [PMID: 35264853 PMCID: PMC8901416 DOI: 10.2147/tcrm.s310371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/13/2022] [Indexed: 11/23/2022] Open
Abstract
Pharmacologic treatment for overactive bladder (OAB), which is characterized by bothersome symptoms such as urgency and urge urinary incontinence (UUI), includes anticholinergics and β3-adrenergic receptor agonists. Anticholinergics are associated with adverse effects including dry mouth, constipation, cognitive impairment, and increased risk of dementia. Therefore, the drug class of β3-adrenergic receptor agonists may represent an effective, safe treatment option. Vibegron, a β3-adrenergic receptor agonist, was approved for use in Japan (2018) and the United States (2020). Over the past 3 years, 2 phase 3 trials (EMPOWUR, EMPOWUR extension) have been conducted with once-daily vibegron 75 mg for the treatment of OAB, and additional secondary and subgroup analyses have detailed the efficacy and safety of vibegron. In the international phase 3 EMPOWUR trial, treatment with vibegron was associated with significant improvements compared with placebo in efficacy outcomes of micturition frequency, UUI episodes, urgency episodes, and volume voided as early as week 2 that were sustained throughout the 12-week trial. The 40-week EMPOWUR extension study, following the 12-week treatment period, demonstrated sustained efficacy in patients receiving vibegron for 52 weeks. Treatment with vibegron was also associated with improvements in patient-reported measures of quality of life. Across studies, vibegron was generally safe and well tolerated. A separate, dedicated ambulatory blood pressure monitoring study showed that treatment with vibegron was not associated with clinically meaningful effects on blood pressure or heart rate. Across all studies, vibegron was efficacious, safe, and well tolerated and thus represents a valuable treatment option for patients with OAB. Here, nearly 1 year after US approval, we review the published data on efficacy and safety of vibegron 75 mg for the treatment of OAB.
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Affiliation(s)
- Jeffrey Frankel
- Seattle Urology Research Center, Seattle, WA, USA
- Correspondence: Jeffrey Frankel, PO Box 1192, Mercer Island, WA 98040, USA, Tel +1 206 972 2775, Email
| | - David Staskin
- Tufts University School of Medicine, Boston, MA, USA
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Patient Experience of Antimuscarinic Treatment for Overactive Bladder: A Qualitative Exploration of Online Forum Content. Female Pelvic Med Reconstr Surg 2022; 28:e49-e54. [PMID: 35272333 DOI: 10.1097/spv.0000000000001156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Antimuscarinic medications are often discontinued, and there is a paucity of data regarding patient experience of medications within this class. OBJECTIVE The objective of this study is to qualitatively explore patient experience of antimuscarinic medications used for overactive bladder using reviews on Drugs.com. STUDY DESIGN We examined reviews prior to February 2, 2020 (available since 2008) for oral antimuscarinic medications. User content was reviewed qualitatively via inductive content analysis. Investigators coded third-party impressions, categorizing each review as positive, mostly positive, mostly negative, or negative. The prevalence of side effects, themes, and impressions are described, with comparisons by drug using χ2, Mann-Whitney U, and Kruskal-Wallis tests, as appropriate. Correlation between ordinal and categorical variables was performed using Tau and Spearman correlation coefficients, respectively. RESULTS We analyzed 469 user reviews. 68.2% reported symptom improvement. The most common side effects were dry mouth (29%) and fatigue (10.7%). Fewer neurologic side effects were reported in the solifenacin (13.9%) and trospium (none) groups (P = 0.009). Tolterodine and trospium immediate release had lower rates of ears, nose, and throat side effects (22.5% and 26.2%, respectively, P = 0.001.) Analysis of themes suggested 2 domains driving overall satisfaction: improvement and side effects. Improvement was associated with a positive satisfaction score (ρ = 0.64, P < 0.001) and gestalt impression (ρ = 0.74, P < 0.001). The factors that most negatively affected these measures were persistent symptoms followed by gastrointestinal side effects (P < 0.001). CONCLUSIONS Our data suggest important differences within this class of medication both in terms of side effects and patient satisfaction. Furthermore, symptom improvement is the leading factor for patient satisfaction, whereas gastrointestinal side effects are associated with dissatisfaction.
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Liao L, Liu Q, Cong H, Xu Z, Li E, Weng Z, Jiang H, Liu B, Huang X, Xia S, Wen W, Wu J, Shi G, Wang Y, Li P, Yu Y, Fang Z, Zheng J, Tian Y, Shang D, Li H, Huang Z, Zhou L, Xiao Y, Zhang Y, Wang J, Zhang X, Zhang P, Wang D, Zhang X, Xie K, Wang B, Ma L, Tian X, Chen L, Dong J. Hengli® Chinese Botulinum Toxin Type A for Treatment of Patients With Overactive Bladder: A Multicenter, Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol 2022; 13:840695. [PMID: 35250586 PMCID: PMC8894806 DOI: 10.3389/fphar.2022.840695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/01/2022] [Indexed: 11/21/2022] Open
Abstract
Objective: To evaluate the efficacy and safety of Hengli® Chinese botulinum toxin type A (BTX-A; 100 U) in Chinese patients with overactive bladder. Methods: This study was a multicenter, randomized, double-blind, placebo-controlled trial in Chinese patients who were inadequately managed with anticholinergic medications. Eligible patients were randomized 2:1 to receive intradetrusor injections of Hengli® BTX-A (n = 144) or placebo (n = 72). The primary endpoint was the change in the number of daily micturition episodes at week 6 from baseline. The secondary efficacy endpoints included the average frequency of urgency and urinary incontinence (UI) episodes per day, urgency score, average micturition volume per day, OABSS, and QoL score. Results: In the Hengli® BTX-A group, there was a significantly greater reduction in the average number of micturition episodes per 24 h compared with the placebo group (3.28 vs. 1.43; p = 0.003). Moreover, there was a significantly greater improvement in the daily number of urgency episodes, micturition volume and OABSS score. An increased post-void residual urine volume, dysuria, and urinary tract infection represented adverse events (AEs) in the Hengli® BTX-A group. Most AEs were mild or moderate in severity. One patient in the BTX-A group initiated clean intermittent catheterization (CIC) during treatment. Conclusion: Hengli® BTX-A treatment was well-tolerated and resulted in significant improvements in OAB symptoms among Chinese patients inadequately managed by anticholinergics. Clinical Trial Registration:http://www.chinadrugtrials.org.cn/clinicaltrials.prosearch.dhtml, Identifier: CTR20131190.
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Affiliation(s)
- Limin Liao
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- *Correspondence: Limin Liao,
| | - Qinggang Liu
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Huiling Cong
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhihui Xu
- Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Enhui Li
- Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Zhiliang Weng
- Department of Urology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haihong Jiang
- Department of Urology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ben Liu
- Department of Urology, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Huang
- Department of Urology, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shujie Xia
- Department of Urology, Shanghai First People’s Hospital, Shanghai, China
| | - Wei Wen
- Department of Urology, Shanghai First People’s Hospital, Shanghai, China
| | - Juan Wu
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guowei Shi
- Department of Urology, Shanghai Fifth People’s Hospital, Shanghai, China
| | - Yang Wang
- Department of Urology, Shanghai Fifth People’s Hospital, Shanghai, China
| | - Peijun Li
- Department of Urology, Ningxia Medical University General Hospital, Xining, China
| | - Yang Yu
- Department of Urology, Ningxia Medical University General Hospital, Xining, China
| | - Zujun Fang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Zheng
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Donghao Shang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhongming Huang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Yunxiang Xiao
- Department of Urology, Peking University First Hospital, Beijing, China
| | | | - Jianlong Wang
- Department of Urology, Beijing Hospital, Beijing, China
| | - Xiaodong Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dongwen Wang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xuhui Zhang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Keji Xie
- Department of Urology, Guangzhou First People’s Hospital, Guangzhou, China
| | - Bin Wang
- Department of Urology, Guangzhou First People’s Hospital, Guangzhou, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lijun Chen
- Department of Urology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jinkai Dong
- Department of Urology, Fifth Medical Center of PLA General Hospital, Beijing, China
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Tilborghs S, De Wachter S. Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects. Expert Rev Med Devices 2022; 19:161-187. [DOI: 10.1080/17434440.2022.2032655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sam Tilborghs
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
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Akman TC, Kadioglu Y, Senol O, Erkayman B. Metabolomics approach: Interpretation of changes in rat plasma metabolites after solifenacin treatment. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kennelly MJ, Rhodes T, Girman CJ, Thomas E, Shortino D, Mudd PN. Efficacy of Vibegron and Mirabegron for Overactive Bladder: A Systematic Literature Review and Indirect Treatment Comparison. Adv Ther 2021; 38:5452-5464. [PMID: 34537953 PMCID: PMC8520873 DOI: 10.1007/s12325-021-01902-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/24/2021] [Indexed: 01/05/2023]
Abstract
Background In the absence of head-to-head trials, we performed an indirect treatment comparison of the β3-adrenergic agonists vibegron and mirabegron in the treatment of overactive bladder (OAB). Methods PubMed, Embase, and Cochrane Library were searched for articles related to phase 3, double-blind, controlled trials of vibegron 75 mg and mirabegron 25/50 mg in patients with OAB. Efficacy outcomes included change from baseline at weeks 4, 12, and 52 in mean daily number of total urinary incontinence episodes and micturitions and mean volume voided/micturition. Effect size was computed as placebo-subtracted change from baseline (weeks 4, 12) or active control (tolterodine)-subtracted change from baseline (week 52) for each treatment group. Adverse events (AEs) are presented descriptively. Results After removal of duplicates, 49 records were identified, and after screening 9 met inclusion criteria for analysis. Vibegron showed significantly greater reduction in mean daily number of total incontinence episodes than mirabegron 25 mg at week 4, mirabegron 50 mg (weeks 4, 52), and tolterodine (weeks 4, 12) (P < 0.05, each) and significantly greater improvement in volume voided versus mirabegron 25 mg (week 12), mirabegron 50 mg (weeks 12, 52), and tolterodine (week 4) (P < 0.05, each). Confidence intervals of point estimates overlapped zero for all other comparisons of vibegron and mirabegron (25 or 50 mg) or tolterodine, indicating no significant differences between treatments for these time/endpoints. Urinary tract infection, hypertension, and dry mouth were the most commonly occurring AEs for vibegron, mirabegron, and tolterodine, respectively, in the short-term trials; hypertension was the most commonly occurring AE with all three treatments in the long-term trials. Conclusions Vibegron was associated with significant improvement in total incontinence episodes versus mirabegron at 4 and 52 weeks and volume voided at 12 and 52 weeks. Improvement in micturitions was similar between vibegron and mirabegron or tolterodine. Incidence of AEs was generally comparable between vibegron and mirabegron. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01902-8.
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Affiliation(s)
- Michael J Kennelly
- Department of Urology, Obstetrics and Gynecology, Carolinas Medical Center, 2001 Vail Ave, Suite 360, Charlotte, NC, 28207, USA.
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Seinen AJ, Elburg R, Hollegien LM, Blanker MH, Witte LPW. The patient pathway for overactive bladder management: A quantitative analysis. Neurourol Urodyn 2021; 41:290-295. [PMID: 34633695 DOI: 10.1002/nau.24817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE We aimed to explore the pathways followed by patients with overactive bladder (OAB) from referral to the urologist to final treatment. METHODS This was a single-center, retrospective cohort study of female patients diagnosed with OAB in a large Dutch nonacademic teaching hospital. The number, sequence, and duration of treatment steps offered were analyzed, and the effectiveness, reasons for discontinuation, and possible case-mix variables influencing OAB treatment were studied. RESULTS In total, 120 patients were enrolled and required a median of 2 steps (range, 1-6) of treatment over a median total duration of 28 weeks (range, 5-256). Treatment typically started with drug therapy, including antimuscarinics (38%; 95% CI, 30%-47%), antimuscarinics plus pelvic floor muscle therapy (21%; 95% CI, 15%-29%), or mirabegron (11%; 95% CI, 6%-18%). However, 52% of patients required further treatment, with botulinum toxin A (BoNT-A) injections being most effective (67%; 95% CI, 42%-85%), followed by antimuscarinics plus percutaneous tibial nerve stimulation (50%; 95% CI, 25%-75%), and antimuscarinics plus pelvic floor muscle therapy (36%; 95% CI, 21%-54%). Other therapies showed lower effectiveness. Common reasons for discontinuation were insufficient response and side effects. Overall, 22 patients were lost to follow-up. CONCLUSION Most patients try at least two treatments before they experience satisfactory symptom relief, with treatment evaluations requiring time because therapeutic onsets differ by patient and treatment. Our data can help to manage expectations among urologists and patients when seeking treatment for OAB.
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Affiliation(s)
- Auke J Seinen
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
| | - Rogier Elburg
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
| | | | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, UMCG, Groningen, The Netherlands
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Gonzalez DC, Khorsandi S, Mathew M, Enemchukwu E, Syan R. A Systematic Review of Racial/Ethnic Disparities in Female Pelvic Floor Disorders. Urology 2021; 163:8-15. [PMID: 34627869 DOI: 10.1016/j.urology.2021.09.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/16/2021] [Accepted: 09/19/2021] [Indexed: 11/24/2022]
Abstract
Numerous studies have investigated the influence of health disparities among women with pelvic floor disorders with varied results. Racial/ethnic disparities, in particular, inconsistently indicate differences in prevalence of disease, disease severity, and treatment outcomes. We aim to review the body of literature examining racial/ethnic disparities in pelvic floor disorders, including overactive bladder, stress urinary incontinence, pelvic organ prolapse, and interstitial cystitis. A better understanding of these disparities may help guide clinicians, researchers, and advocates in providing improved education, outreach opportunities, and access to care in minority women with pelvic floor disorders.
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Affiliation(s)
- Daniel C Gonzalez
- Department of Urology, Division of Female Urology, University of Miami, Miami, FL
| | - Shayan Khorsandi
- Department of Obstetrics and Gynecology, Division of Urogynecology, Stanford University, School of Medicine, Stanford, CA
| | - Megan Mathew
- Department of Urology, Division of Female Urology, University of Miami, Miami, FL
| | - Ekene Enemchukwu
- Department of Urology, Stanford University, School of Medicine, Stanford, CA
| | - Raveen Syan
- Department of Urology, Division of Female Urology, University of Miami, Miami, FL.
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Kira S, Miyamoto T, Tsuchiya S, Nakagomi H, Ihara T, Sawada N, Takeda M, Mitsui T. Potential Targets for Overactive Bladder in Older Men Based on Urinary Analysis of Metabolomics. Urol Int 2021; 106:672-678. [PMID: 34569539 DOI: 10.1159/000518300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We investigated the association between overactive bladder (OAB) and urinary metabolites in men. METHODS This prospective observational study included 42 men aged 65-80 years. The 3-day frequency volume chart (FVC), International Prostate Symptom Score (IPSS), and quality of life score were adapted to assess the micturition behavior. Participants with IPSS urgency score ≥2 were included in the OAB group, and those with IPSS urgency score <2 were included in the control group. We performed a comprehensive metabolomic analysis using urine samples. Metabolites were compared between the groups using an unpaired t test and Fisher's exact test in a nonadjusted analysis. Multivariable logistic regression analysis was performed to investigate the association between OAB and the metabolites. RESULTS Overall, 23 men were included in the OAB group and 19 in the control group. There were no differences in the background factors except age between the groups. FVC analysis demonstrated that nocturnal urine volume, 24-h micturition frequency, and nocturnal micturition frequency were significantly higher, and the maximum voided volume was significantly lower in the OAB group than in the controls. Metabolomic analysis revealed 14 metabolites that were differentially expressed between the groups. Multivariate analysis indicated that an increase in the levels of 5-iso prostaglandin F2α-VI (5-iPF2a-VI) and 5-methoxyindoleacetic acid was associated with OAB. CONCLUSION Abnormal urinary metabolites, including metabolites in the tryptophan (5-methoxyindoleacetic acid, 3-indoleacetonitrile, and 3-hydroxyanthranilic acid) and arachidonic acid (5-iPF2a-VI) pathways, play a role in the pathogenesis of OAB in older men.
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Affiliation(s)
- Satoru Kira
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Tatsuya Miyamoto
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Sachiko Tsuchiya
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Hiroshi Nakagomi
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Tatsuya Ihara
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Norifumi Sawada
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Masayuki Takeda
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Takahiko Mitsui
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
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Ali M, Landeira M, Covernton PJO, Choudhury N, Jaggi A, Fatoye F, van Maanen R. The use of mono- and combination drug therapy in men and women with lower urinary tract symptoms (LUTS) in the UK: a retrospective observational study. BMC Urol 2021; 21:119. [PMID: 34474675 PMCID: PMC8414666 DOI: 10.1186/s12894-021-00881-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combination drug therapy for lower urinary tract symptoms (LUTS) is beneficial to selected patients and recommended by guidelines. Patterns of real-world LUTS drug use, especially combination drug therapy, have not been studied extensively. Moreover, further understanding of the recent landscape is required following the introduction of the beta-3-adrenoceptor agonist mirabegron in the UK in 2013 for overactive bladder (OAB). The objective was to describe mono- and combination drug therapy use for LUTS in patients in UK clinical practice. METHODS This was a retrospective, descriptive, observational database study using UK Clinical Practice Research Datalink GOLD and linked databases. Men and women ≥ 18 years with a first prescription for any LUTS drug from 2014 to 2016 with ≥ 12 months continuous enrollment pre- and post-index date were included. Primary endpoints were mono- or combination drug therapy use for LUTS in male and female cohorts. Secondary endpoints were description of treatment prescribed, treatment persistence and patient demographics. Data were analyzed descriptively. Sub-cohorts were defined by drugs prescribed at index date. RESULTS 79,472 patients (61.3% male) were included, based on index treatments. Of all men, 82.5% received any benign prostatic obstruction (BPO) drug, 25.4% any OAB drug, and 7.9% any BPO drug plus any OAB drug. As either mono- or combination drug therapy, 77.1% received an alpha-blocker, 18.9% a 5-alpha reductase inhibitor, 23.9% an antimuscarinic agent, and 2.1% mirabegron. Of all women, 94.5% received any OAB drug, 6.0% duloxetine, and 0.5% any OAB drug plus duloxetine. As either mono- or combination drug therapy, 87.7% received an antimuscarinic, and 9.7% mirabegron. In men or women receiving OAB treatment, approximately 2.5% received combination drug therapy with an antimuscarinic agent and mirabegron. For OAB drug monotherapies, mirabegron had the highest persistence in both male and female cohorts. CONCLUSIONS This study provides a better understanding of the recent landscape of LUTS drug use in UK clinical practice. It highlights potential undertreatment of storage symptoms in men with LUTS and the low use of combination OAB treatments.
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Affiliation(s)
- Mahmood Ali
- Manchester Metropolitan University, Manchester, UK. .,Astellas Pharma Europe Ltd, Addlestone, UK.
| | | | | | | | - Ashley Jaggi
- Manchester Metropolitan University, Manchester, UK.,Astellas Pharma Europe Ltd, Addlestone, UK
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Wani MM, Sheikh MI, Bhat T, Bhat Z, Bhat A. Comparison of antimuscarinic drugs to beta adrenergic agonists in overactive bladder: A literary review. Curr Urol 2021; 15:153-160. [PMID: 34552455 PMCID: PMC8451319 DOI: 10.1097/cu9.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/20/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to carry an extended literature review to compare antimuscarnics with beta adrenergic agonists (mirabegron) in treatment of overactive bladder. MATERIALS AND METHODS A literature review was carried out, using key words in different databases including MEDLINE, PUBMED, and EMBASE. All relevant published articles during last 5 years with full texts available were included in this review for critical analysis and evaluation. In total, there were 20 studies including 7 systemic reviews, 6 retrospective cohort, 3 prospective cohort, 2 randomized controlled trials, and 2 cross sectional studies. RESULTS After critical evaluation the results were considered under parameters of efficacy, adverse effects, adherence and persistence, tolerability, cost-effectiveness. In 9 studies efficacy was evaluated, 5 studies dealt with adverse effects, same number evaluated adherence and persistence. Cost effectiveness was compared in 3 and same number of studies also compared tolerability. CONCLUSIONS To conclude, we found mirabegron is as efficacious as any other antimuscarnics, has better tolerability (including elderly), has better adverse effect profile, is cost effective, has better persistence and adherence rates at 12 months.
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Affiliation(s)
- Mudassir M. Wani
- Department of Urology, Glangwili General Hospital, Carmarthen, Wales, UK
| | | | - Tahir Bhat
- Department of Urology, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Zubair Bhat
- Department of Urology, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Arshad Bhat
- Department of Urology, Hereford County Hospital, Hereford, Herefordshire, UK
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