Comparative Assessment of Efficacy and Safety of approved Oral Therapies for Overactive Bladder: A Systematic Review and Network Meta-analysis

Abstract

Purpose To compare the effectiveness and safety of marketed oral drugs for the treatment of overactive bladder. Methods Pubmed, Embase, Web of Science, and The Cochrane Register of Clinical Trials databases were systematically searched. The search time frame was from database creation to June 2, 2022, and randomized controlled double-blind trials of oral drugs for overactive bladder were screened. Trials were evaluated for quality using the Cochrane Risk of Bias Assessment Tool, and data were statistically analyzed using Stata 16.0 to compare and rank differences in effectiveness and safety. Result A total of 60 randomized controlled double-blind trials were included. Solifenacin 10mg was the most effective in micturitions and incontinence episodes, solifenacin 5/10mg in urgency and nocturia, fesoterodine 8mg in urgency incontinence and oxybutynin 5mg in voided volume/micturition. For safety, mirabegron, vibegron, solifenacin 5mg, extended-release tolterodine 4mg and extended-release oxybutynin 10mg all showed a better incidence of dry mouth; Compared to placebo, only imidafenacin 0.1mg, showed a significantly increased incidence in hypertension, solifenacin 10mg in urinary tract infection, fesoterodine 4/8mg and controlled release darifenacin 15mg in headache. Conclusion Solifenacin showed better efficacy. For safety, most anticholinergics were more likely to cause dry mouth and constipation, while β-adrenergic agonists showed an increased incidence of nasopharyngitis. The choice of therapeutic agent should be tailored to the patient's situation in order to find the best balance between efficacy and safety.