Comparative Effectiveness of Botulinum Toxin a Versus Placebo for Neurogenic Overactive Bladder: A Meta-Analysis

Area of Science:

• Urology
• Neurology
• Pharmacology

Background:

• Lower urinary tract dysfunctions are prevalent globally, particularly in patients with neurological diseases.
• Neurogenic detrusor overactivity (NDO) is a common and impactful manifestation of these dysfunctions.
• Onabotulinumtoxin A (BTXA) is a standard treatment for NDO.

Purpose of the Study:

• To evaluate the efficacy and safety of Onabotulinumtoxin A for treating neurogenic bladder.
• To assess the impact of different Onabotulinumtoxin A dosages on treatment outcomes.

Main Methods:

• A systematic literature review and meta-analysis of randomized, double-blind, placebo-controlled trials.
• Included seven RCTs with 1592 patients, analyzing urodynamic parameters (MCC, MDP) and urinary incontinence (UI) episodes.
• Safety assessed via incidence of adverse events (AEs), specifically urinary tract infections (UTI) and urinary retention (UR).

Main Results:

• Onabotulinumtoxin A significantly increased Maximum Cystometric Capacity (MCC) and decreased Maximum Detrusor Pressure (MDP) in both 200U and 300U groups.
• No significant effect was observed on the mean number of urinary incontinence episodes per week.
• Increased incidence of UTI and urinary retention was noted in Onabotulinumtoxin A treated groups.

Conclusions:

• Onabotulinumtoxin A demonstrates efficacy in improving key urodynamic parameters for NDO.
• Treatment with Onabotulinumtoxin A is associated with a slightly elevated risk of UTI and UR.
• The findings support Onabotulinumtoxin A as a beneficial treatment option for NDO, with careful consideration of potential side effects.