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Newer agents for the management of overactive bladder
Benjamin J Epstein1, John G Gums, Emerson Molina
1University of Florida, Gainesville, Florida, USA. epstein@cop.ufl.edu
American Family Physician
|December 26, 2006
Summary
Newer overactive bladder medications like trospium, solifenacin, and darifenacin offer improved tolerability over older anticholinergics. While generally as effective, individual patient factors guide optimal selection for managing urinary incontinence.
Area of Science:
- Pharmacology
- Urology
Background:
- Older anticholinergics (tolterodine, oxybutynin) for overactive bladder (OAB) cause side effects due to non-selective muscarinic receptor activity.
- Newer agents (trospium, solifenacin, darifenacin) approved in 2004 offer potential for improved tolerability and bladder selectivity.
Purpose of the Study:
- To review the efficacy and tolerability of newer OAB medications compared to older agents.
- To highlight pharmacokinetic differences for personalized treatment selection.
Main Methods:
- Review of clinical trials comparing newer OAB agents (trospium, solifenacin, darifenacin) with placebo and older agents (oxybutynin, tolterodine).
- Analysis of studies assessing effects on incontinence episodes, voiding frequency, urgency, and quality of life.
Main Results:
- Newer agents effectively reduce incontinence, voiding frequency, and urgency, improving quality of life compared to placebo.
- Head-to-head trials suggest newer agents are better tolerated than immediate-release older drugs, with similar effectiveness.
- Solifenacin showed a trend towards greater efficacy than extended-release tolterodine in one study, with comparable tolerability.
Conclusions:
- Newer OAB medications demonstrate comparable efficacy to older agents, with potentially improved tolerability.
- Pharmacokinetic profiles and individual patient factors are crucial for selecting the most appropriate OAB treatment.
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