Roger Dmochowski, MD, FACS
What are the benefits and harms of drug therapy for urgency urinary incontinence (UI) in community-dwelling women?
Included studies compared drugs available in the USA for urgency UI (darifenacin, fesoterodine, oxybutynin, trospium, solifenacin, and tolterodine) with each other or placebo and enrolled ≥ 75% women. Outcomes included continence and treatment discontinuation due to adverse effects (AEs).
MEDLINE, Cochrane Library, SCIRUS, Google Scholar, US Food and Drug Administration reviews, and clinical trial registries were searched for English-language, randomized, controlled trials (RCTs) and individual patient data (IPD) analyses. 94 studies met selection criteria; 8 were IPD analyses. Risk for bias was low: 73% studies adequately described randomization, 23% had clear allocation concealment, 39% performed intention-to-treat analyses, and 99% were double-blind.
Fesoterodine, oxybutynin, solifenacin, tolterodine, and trospium each improved continence compared with placebo (Table). Fesoterodine and oxybutynin had higher rates of discontinuation, whereas solifenacin and trospium had borderline increases (Table).
Drugs for urgency urinary incontinence improve continence in women. Fesoterodine and oxybutynin are more frequently discontinued due to adverse effects than other drugs.
Active drugs vs placebo for urgency urinary incontinence in women*
*NS = not significant; other abbreviations defined in Glossary. RBI, NNT, and CI for continence calculated from relative risks and risk differences in article using a random-effects model. RRI and CI for discontinuation calculated from control event rates and Bayesian odds ratios in article using a random-effects model; NNH calculated from the reported risk difference.
†Treatment discontinuation due to adverse effects.
Dmochowski R. Review: Drugs for urgency urinary incontinence improve continence in women. Ann Intern Med. ;157:JC4–4. doi: 10.7326/0003-4819-157-8-201210160-02004
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Published: Ann Intern Med. 2012;157(8):JC4-4.
Nephrology, Urological Disorders.
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