Efficacy and duration of response to botulinum neurotoxin A (onabotulinumA) as a treatment for detrusor overactivity in women

Chohan, Navjeet; Hilton, Paul; Brown, Karen; Dixon, Liz

doi:10.1007/s00192-015-2751-4

Cited by 24 publications

(24 citation statements)

References 19 publications

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“…In our study, therapeutic discontinuation occurred at 75.8 months on average, which corresponds to the data found in the literature . However, there is a discrepancy with the study by Chohan et al, which showed that BoNT‐A lost its efficiency by the fifth injection, with only 19.9% of patients pursuing the treatment after the fifth cycle.…”

Section: Discussionsupporting

confidence: 68%

How long does the effect of botulinum toxin in neurogenic patients last? An analysis of the subset of “good responders”

Dominique

Tremblais

Charvier

et al. 2019

LUTS

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Background: The aim of this study was to assess long-term efficacity of botulinum neurotoxin A (BoNT-A) in the treatment of neurogenic detrusor overactivity (NDO). Materials and Methods:This was a retrospective monocentric study in a reference center. We included patients who received intradetrusor BoNT-A for NDO between 2001 and 2015. The focus of our analysis was on patients defined as "good responders" (≥ 5 injections of intradetrusor BoNT-A over a period of ≥5 years). The primary endpoint was the evaluation of long-term efficacity of BoNT-A. Recurrent NDO was monitored by the use of cystomanometry before the first injection and 1 month after each injection.The secondary objective was to assess the influence of NDO's etiology, age, and sex on the long-term efficacity of the treatment.Results: A total of 107 patients were included (60.7% with spinal cord injury [SCI] and 36.4% with multiple sclerosis [MS]). The mean follow-up period was 83.7 months (66; 120). The mean number of injections was of 8.9 (5; 21). A total of 67.3% (n = 72) of patients were still controlled by treatment at the end of their follow-up period.Therapeutic failure occurred in 30 patients (26.1%) with a cessation of BoNT-A treatment at 76 months on average (median: 82.5 months). There was no significant impact of age (P = .42), sex (P = .35), or NDO's etiology (MS vs SCI; P = .54) on longterm efficacy of BoNT-A treatment. Conclusion:The results of our study indicate that the application of BoNT-A seems to be an effective and durable treatment in a large number of neurogenic patients after more than 10 years of follow-up. However, botulinum toxin tolerance occurred in approximately 25% of patients. K E Y W O R D S botulinum toxin, detrusor overactivity, neurogenic, overactive bladder 1 | INTRODUCTION Botulinum neurotoxin A (BoNT-A) was isolated from Clostridium botulinum bacteria and was used in urology for the first time in 1998 in the urethral striated sphincter to treat detrusor sphincter dyssynergia. 1Since then, the scope of BoNT-A in urology has widened. It now plays a major part in the treatment of neurogenic detrusor overactivity (NDO) 2-4 and idiopathic detrusor overactivity, 5-7 with proven effectiveness.NDO is a chronic pathology. Patients do not always respond well to first-line treatments and have an impaired quality of life as a result.

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Section: Discussionsupporting

confidence: 68%

How long does the effect of botulinum toxin in neurogenic patients last? An analysis of the subset of “good responders”

Dominique

Tremblais

Charvier

et al. 2019

LUTS

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“…Although improvements in the mean urinary frequency, incontinence, and urgency episodes continued to be significant at the 12th postoperative week and 9th postoperative month, improvements in the mean bladder and maximum volume capacities were no longer significant at the 9th postoperative month compared with the baseline. In most studies, the effects of a 100 U onaBoNT‐A injection were maintained for up to 11.1 months . Thus, we evaluated the efficacy, and the need for repeated injections through the 9th postoperative month.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population

Önem

Bayrak

Demirtaş

et al. 2017

Neurourology and Urodynamics

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Aims: To investigate the efficacy and safety of intradetrusor onabotulinumtoxinA (onaBoNT-A) injection in patients with overactive bladder (OAB) refractory to antimuscarinic treatment.Methods: A total of 80 patients with OAB symptoms were enrolled in this prospective multicenter study and received 100 U intradetrusor onaBoNT-A injection.The changes from baseline in the frequency of voiding, urge urinary incontinence (UI) and urge episodes, mean and maximum bladder capacities, uroflowmetry, post-void residual urine volume (PVR), quality of life score, and treatment benefit scale score were assessed. The need for a second injection,and treatment-related adverse events were also examined postoperatively.Results: OnaBoNT-A injection significantly decreased the UI episodes (P = 0.0001), the mean voiding frequency (P = 0.0001), and the urgency episodes (P = 0.0001) in the third month compared to baseline. Similarly, the mean bladder capacity, and maximal bladder capacity were increased (P < 0,05). The quality of life scores improved by 57.1% compared to the pretreatment rate (P = 0,0001). No significant change was observed in the PVR or maximum flow rate. Urinary retention developed in 3 (3.75%) patients and urinary infection and transient hematuria were observed in five patients (6.25%) each. The UI episodes, voiding frequency and urgency episodes were significantly lower at the 9th month than at baseline (all P = 0.0001).Overall 67% of the patients continued to experience benefits from the injection. Sixteen patients (20%) required a second injection in the third month. Eight patients were lost to follow-up at the last visit in the 9th month, and 34 of the remaining 56 patients required a second injection at the 9th month. Cumulatively, 50 (63%) patients needed re-injections. Conclusions:Our results demonstrated that the onaBoNT-A injection produced significant improvement in all OAB symptoms with a low incidence of treatment related adverse events.

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“…Many second and third-line treatments for SUI and UUI have inconsistent outcomes, uncertain durability, and high risk of complications. 2122 For LUTS associated with benign prostatic hyperplasia (BPH), randomized clinical trials (RCT) have demonstrated the efficacy of commonly used pharmacologic therapies in men, but the beneficial effects of treatment may not be generalizable, can be costly because of long-term use, and produce numerous, often intolerable side-effects, which reduces adherence. 23 For interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), numerous medical interventions have been proposed; however, effective treatment remains elusive.…”

Section: Challenges With Current Treatment Of Lutsmentioning

confidence: 99%

Advancing a Comprehensive Approach to the Study of Lower Urinary Tract Symptoms

et al. 2016

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Purpose Lower urinary tract symptoms (LUTS) are common in the United States leading to a significant economic, quality-of-life, and public health burden. This burden will increase as the population ages and risk factors for LUTS such as diabetes and obesity remain highly prevalent. Improving clinical management and establishing the knowledge base to prevent LUTS will require a comprehensive research approach that examines factors beyond the lower urinary tract (LUT). While the study of these “extra-LUT” factors has increased recently, current urologic research does not systematically account for the broad set of potential LUTS contributors that span biologic, behavioral, psychological/executive function, and sociocultural factors. A comprehensive assessment of potential contributors to LUTS risk, treatment response, and progression is necessary to reduce the burden of this condition within the United States. Materials and Methods We consider challenges to continuing the predominantly LUT dysfunctioncentric approach that has dominated previous LUTS research, and propose a new, comprehensive framework for future urology research that includes a broader set of potential LUTS contributors. Results and Conclusions This comprehensive approach should help reduce the medical and economic burden of LUTS in the U.S. population.

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Efficacy and duration of response to botulinum neurotoxin A (onabotulinumA) as a treatment for detrusor overactivity in women

Abstract: Our results suggest that in patients who respond to onabotulinumA treatment, the duration of response declines after the fifth treatment, suggesting a possible tolerance effect and a subsequent decline in efficacy.

Cited by 24 publications

References 19 publications

How long does the effect of botulinum toxin in neurogenic patients last? An analysis of the subset of “good responders”

How long does the effect of botulinum toxin in neurogenic patients last? An analysis of the subset of “good responders”

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population

Advancing a Comprehensive Approach to the Study of Lower Urinary Tract Symptoms

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