Title:Antimuscarinics in the Treatment of OAB: Is there a First-Line and a Second-Line Choice?
Volume: 16
Issue: 11
Author(s): Apostolos Apostolidis
Affiliation:
Keywords:
Antimuscarinics, anticholinergics, systematic review, meta-analysis.
Abstract: Antimuscarinics are currently the mainstay of pharmacotherapy of the overactive bladder
(OAB) syndrome. Several meta-analyses have confirmed their efficacy in comparison with placebo, although
the clinical significance of differences in parameters recorded in clinical trials has been questioned.
Trials examining the effect of antimuscarinics on outcomes which matter to the patients, such
as subjective cure/improvement rates, quality of life parameters and cost-effectiveness are relatively
limited. Also, comparative studies between the various available drugs have been designed to support
the registration requirements and rarely provide information critical for a physician who needs to assess
the best first-line choice for the specific patient, or even a second-line management. Data which might be useful for
clinicians who would embark on tailoring the management of OAB for the individual patient could be found in systematic
reviews/meta-analyses, cost-effectiveness studies and studies investigating the patients’ adherence to treatment and persistence
with pharmacotherapy for OAB. In addition, patient co-morbidities and concurrent treatments should be taken into
consideration in conjunction with the safety profile of each antimuscarinic. Available evidence suggests that the use of ER
formulations of antimuscarinics is favoured over the IR formulations when concerning best balance between efficacy and
adverse events, cost-effectiveness, adherence and persistence with treatment.
