Where will the next generation of medical treatments for overactive bladder syndrome come from?

Abstract

This review article discusses the medical need for improved medical treatments of overactive bladder syndrome, and the hurdles and research required to address that need. Currently, few overactive bladder syndrome patients stay on long‐term treatment, largely because efficacy expectations are not met, and tolerability is considered insufficient for the chronic treatment of a non‐life‐threatening condition. Therefore, a medical need exists for improved tolerability and, even more importantly, improved efficacy. It is unlikely that major improvements of efficacy and tolerability can be achieved within the currently approved drug classes. Work in experimental animals suggests that many causes of overactive bladder syndrome exist – each with a distinct pathophysiology. This makes it unlikely that a single medication can address the pathophysiology and treatment needs of all overactive bladder syndrome patients; accordingly, any medication will appear to have only moderate efficacy in the overall group of overactive bladder syndrome patients, even if it fully eliminates symptoms within a subset of patients. It is proposed that only identification of subsets of patients with a defined pathophysiology (and biomarkers thereof) will allow the development and use of targeted treatment that can be highly effective in such subsets.

The patient pathway for overactive bladder management: A quantitative analysis

“…To resolve these limitations, a larger population should be studied prospectively, preferably in a multicenter (pragmatic) trial. This should not only account for the case‐mix variables set out by the ICHOM 17 but also identify specific OAB subgroups with shared symptoms (e.g., urgency‐ or nocturia‐dominant OAB) 20 . Finally, no side effects were reported after PFMT and BoNT‐A injections, which we think was probably due to under‐reporting.…”

Medicamenteuze behandeling van de overactieve blaas: het heden en de toekomst

“…Een ander probleem is dat niet alle symptomen die bij OAB horen, zoals urgency, frequency, aandrangsincontinentie en nycturie, in dezelfde mate afnemen na behandeling. De effecten op aandrangsincontinentie en frequency zijn in sommige observationele studies veel groter dan de effecten op urgency en nycturie [2]. In de meeste onderzoeken hebben muscarineantagonisten zelfs helemaal geen effect op nycturie in vergelijking met placebo [3].…”

Editorial Comment to Where will the next generation of medical treatments for overactive bladder syndrome come from?

“…is a question that concerns every office urologist. 1 Overactive bladder (OAB) represents a common condition characterized by bothersome symptoms, such as frequent urination and urgency, and it occurs more commonly in the elderly. 2 As Japan is experiencing a striking speed in the growing aging population, which has never been seen in the world, it can be easily expected that urology physicians would face more OAB patients in the future.…”

“…“Where will the next generation of medical treatments for overactive bladder syndrome come from?” is a question that concerns every office urologist . Overactive bladder (OAB) represents a common condition characterized by bothersome symptoms, such as frequent urination and urgency, and it occurs more commonly in the elderly .…”