Clinician Article
Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review.
PMID: 22711079
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GeriatricsRelevance - 7/7
Newsworthiness - 6/7 -
Family Medicine (FM)/General Practice (GP)Relevance - 6/7
Newsworthiness - 4/7 -
General Internal Medicine-Primary Care(US)Relevance - 6/7
Newsworthiness - 4/7 -
GynecologyRelevance - 5/7
Newsworthiness - 5/7 -
Surgery - UrologyRelevance - 5/7
Newsworthiness - 5/7
Abstract
BACKGROUND: Urinary incontinence (UI) in women adversely affects quality of life.
PURPOSE: To conduct a systematic literature review of drugs for urgency UI in women.
DATA SOURCES: MEDLINE, the Cochrane Central Register of Controlled Trials, SCIRUS, and Google Scholar were searched for articles published from 1966 to November 2011.
STUDY SELECTION: Randomized, controlled trials (RCTs) reported in English.
DATA EXTRACTION: Rates of outcomes and risk of bias were extracted by using a standardized form to pool absolute risk differences and calculate the number of attributable events per 1000 patients treated, with 95% CIs.
DATA SYNTHESIS: 94 RCTs were eligible. Pooled analyses showed that among drugs for urgency UI, per 1000 treated women, continence was restored in 130 with fesoterodine (CI, 58 to 202), 85 with tolterodine (CI, 40 to 129), 114 with oxybutynin (CI, 64 to 163), 107 with solifenacin (CI, 58 to 156), and 114 with trospium (CI, 83 to 144). Rates of treatment discontinuation due to adverse effects were 31 per 1000 treated with fesoterodine (CI, 10 to 56), 63 with oxybutynin (CI, 12 to 127), 18 with trospium (CI, 4 to 33), and 13 with solifenacin (CI, 1 to 26). The studies' inconsistent definitions of reduction in UI and quality of life hampered synthesis of evidence.
LIMITATION: Evidence for quality-of-life improvements and comparative effectiveness with drugs was limited, and evidence for the effects of race, baseline severity of UI, and comorbid conditions on treatment success was insufficient.
CONCLUSION: Overall, drugs for urgency UI showed similar small benefit. Therapeutic choices should consider the harms profile. Evidence for long-term adherence and safety of treatments is lacking.
Clinical Comments
General Internal Medicine-Primary Care(US)
Good review of commonly used medications looking at relative value/effectiveness of each.
General Internal Medicine-Primary Care(US)
Incontinence is a common problem in primary care practice and medications are often prescribed. This review helps providers realize that the benefits of these drugs are modest and discontinuation rates are high.
Geriatrics
A must-read article for every physician taking care of older adults.
Gynecology
As a Urogynecologist the findings of this study did not particularly surprise me, but it does provide an elegant summary. There are a number of new products for the treatment of urgency incontinence introduced over the past few years. This paper emphasizes that there is not one drug in the USA that is superior, and side effects are significant for all available medications. The authors also aknowledge a low treatment effect. They accept the potential of publication bias with less favourable studies likely not published, and acknowledge that the study analyzes multiple reports of the same data. The current report is a "best case scenario". My take-home message is that, although medication can be helpful in managing urgency incontinence, the relatively poor treatment effect and the potential for side effects emphasize the need to focus on lifestyle treatments rather than relying on medication.
Gynecology
NNT is greater than 5, so >80% of patients given these medications will not benefit. Adverse effect profiles differ between drugs and are a useful factor for choosing one drug over another.
Gynecology
Confirms impression from practice.
Surgery - Urology
Excellent and comprehensive systematic review and meta-analysis of this topic. Practitioners should know this summary and use it for counseling their patients. Hopefully, clinical guidelines will follow this information in future updates as well.
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