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Elevating our therapeutic expectations in overactive bladder
1Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine Evanston, Illinois, USA.
Abstract:
Drug therapy for overactive bladder (OAB) most commonly includes antimuscarinic agents, which work by relaxing bladder smooth muscle through inhibition of acetylcholine receptors in the bladder. The major adverse effects with existing antimuscarinic agents are anticholinergic in nature (e.g., dry mouth, constipation, blurred vision). Oxybutynin and tolterodine have been used for several years for treatment of OAB; both are available in immediate- and extended-release formulations. Fewer or less severe adverse effects are reported with the extended- versus the immediate-release formulations, with little or no difference in efficacy. Oxybutynin is also available as a transdermal patch. Trospium, which was recently approved for use in the United States, has efficacy and an incidence of dry mouth similar to existing agents but does not cross the blood-brain barrier. It requires twice-daily dosing. Two new antimuscarinic agents--darifenacin and solifenacin--are in development. Both show significantly better efficacy compared with placebo for key symptoms of OAB, including urgency. The incidence of dry mouth at the lowest effective dose is 19% for darifenacin and 8% and 14% for solifenacin (2 studies).
Insights
Antimuscarinic drugs treat overactive bladder (OAB) by relaxing bladder muscles. Extended-release formulations and newer agents like darifenacin and solifenacin may offer improved side effect profiles for OAB management.
Area of Science:
- Pharmacology
- Urology
Background:
- Overactive bladder (OAB) is commonly treated with antimuscarinic agents that inhibit acetylcholine receptors.
- Major side effects of current antimuscarinics are anticholinergic, including dry mouth and constipation.
- Oxybutynin and tolterodine are established OAB treatments available in various formulations.
Purpose of the Study:
- To review current drug therapy for overactive bladder (OAB).
- To compare the efficacy and adverse effects of existing and emerging antimuscarinic agents for OAB.
Main Methods:
- Review of existing literature on antimuscarinic drugs for OAB.
- Comparison of adverse effect profiles and efficacy data for various agents.
Main Results:
- Extended-release formulations of oxybutynin and tolterodine show fewer side effects than immediate-release versions with similar efficacy.
- Trospium has similar efficacy and dry mouth incidence to existing agents but does not cross the blood-brain barrier.
- Newer agents, darifenacin and solifenacin, demonstrate improved efficacy for OAB symptoms, including urgency, with lower rates of dry mouth at effective doses.
Conclusions:
- Extended-release formulations and newer antimuscarinic agents represent advancements in OAB treatment.
- Emerging drugs like darifenacin and solifenacin show promise for managing OAB with potentially reduced anticholinergic side effects.
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