OnabotulinumtoxinA for overactive bladder in patients treated with 1 or more oral medication

Data is scarce for a comparison of the efficacy of onabotulinumtoxinA (onabotA) for treatment of overactive bladder between patients treated with 1 oral overactive bladder (OAB) medication vs patients treated with more than 1, according to the authors of an abstract presented at the 2022 American Urogynecologic Society and International Urogynecologic Association’s 47th Annual Meeting held virtually and in-person in Austin, Texas from June 14-16, 2022.¹

To combat this lack of data, the investigators conducted a study that evaluated real-world urinary incontinence episodes and the benefit of onabotA in individuals who are refractory to 1 or more oral medications. This prospective, observational study (NCT02161159), enrolled adult OAB patients whose symptoms are inadequately managed by oral medications.

In the study, participants were naïve to botulinum toxin for OAB. Additionally, efficacy and safety analyses were conducted on patients who received >1 dose of onabotA, and adverse events (AEs) and adverse drug reactions (ADRs) were documented up to 12 months after onabotA treatment.

The investigators examined UI episodes at baseline for all participants who took oral medications (b-3 adrenergic agonist [b-3] and/or an anticholinergic [AC]) for OAB. Patients who took oral medications before, but not after onabotA treatment and had >1 diary entry at the designated timepoint were the only ones incorporated in the analyses of UI episodes.

Results of the study demonstrated that baseline episodes of patients treated with 1 oral medication were similar to those who took more than 1 oral medication. Also, reductions in UI at Week 12 following onabotA were not different based on the number of prior oral medications.

Moreover, 233 patients reported TBS at week 12, and of those patients, 88% were improved or greatly improved after onabotA treatment.

Safety data recorded 57 AEs in 38 patients (7.5%), 9 of which were serious. Also, urinary retention was reported in 5 patients (1.0%), and symptomatic urinary tract infection was reported in 2 patients (0.4%).

The authors concluded, “Treatment with onabotA led to significant reductions in UI episodes, with no significant improvement in patients who had been on more than one oral as compared to only one oral before onabotA treatment. Given these results, clinicians may want to consider onabotA treatment earlier as opposed to cycling through oral medications.”

Reference

1. Farrelly E, Lorenzo-Gomez M, Schulte-Baukloh H, Nelson M, Hamid R. OnabotulinumtoxinA Improves Idiopathic Overactive Bladder Symptoms in Patients Refractory to Oral Medications. Poster presentation at the AUGS and IUGA 2022 Scientific Meeting. June 14-18, 2022. Austin, Texas.