Current and future drugs for treatment of MS-associated bladder dysfunction

Area of Science:

• Neurology
• Urology
• Pharmacology

Background:

• Lower urinary tract symptoms (LUTS) are a common complication for multiple sclerosis (MS) patients.
• Current treatments for neurogenic detrusor overactivity (NDO) in MS, such as antimuscarinics, lack extensive efficacy and safety data.
• Onabotulinumtoxin A injections offer an alternative when conservative treatments fail, with significant symptom improvement reported in many patients.

Purpose of the Study:

• To review current and emerging treatment options for LUTS in MS patients.
• To evaluate the potential impact of new disease-modifying therapies (DMTs) for MS on LUTS.
• To emphasize the importance of a multidisciplinary approach in managing MS-related LUTS.

Main Methods:

• Literature review of existing treatments for NDO and LUTS in MS.
• Analysis of the potential effects of novel MS disease-modifying drugs on urinary symptoms.
• Discussion of treatment strategies considering both underlying MS pathophysiology and symptomatic relief.

Main Results:

• Antimuscarinic treatments are standard but have limited evidence for MS-induced NDO.
• Onabotulinumtoxin A injections demonstrate high efficacy in improving or resolving LUTS in a majority of treated MS patients.
• New MS DMTs may influence LUTS, but their specific efficacy and safety for urinary symptoms are not well-established.

Conclusions:

• Management of MS-related LUTS requires a comprehensive strategy, prioritizing treatment of the underlying MS.
• Novel MS DMTs should be considered adjuncts for LUTS, not primary treatments.
• Joint decision-making between neurologists and urologists is crucial for optimizing LUTS management in MS patients, considering potential side effects and limited specific data.