Longer Course of Solifenacin Does Not Reduce Overactive Bladder Recurrence

By Marilynn Larkin

May 03, 2019

NEW YORK (Reuters Health) - Prolonged anti-muscarinic treatment with solifenacin does not decrease the risk for retreatment of overactive bladder, researchers say.

Dr. Ho-Hsiung Lin of National Taiwan University College of Medicine in Taipei and colleagues randomly assigned women (mean age, about 60) with at least a three-month history of overactive bladder symptoms (e.g., urinary urgency with or without incontinence, an average of more than eight micturitions in 24 hours) to receive 5 mg solifenacin for three or six months. To avoid treatment bias, participants did not use lifestyle modifications or bladder training during the study.

As reported online April 16 in Maturitas, 91 women were assigned to each group, with 69% of those in the three-month group and 59% of those in the six-month group completing treatment.

Although the authors suspected the probability of retreatment would differ between the groups, their analysis found that it did not. The two-year retreatment-free probabilities of the three-month and six-month groups were 0.68 and 0.85, respectively.

Independent predictors of retreatment were parity (hazard ratio = 1.81), number of incontinence episodes (HR = 1.09) and suboptimal response, defined as lack of response at the last study visit (HR = 3.56).

Physical limitation, as indicated on the King's Health Questionnaire, was the only independent factor predicting completion of the scheduled treatment period (odds ratio, 1.01).

American Urological Association spokesperson Dr. Roger Dmochowski of Vanderbilt University Medical Center in Nashville told Reuters Health, "The authors present an intriguing study, again demonstrating issues with medical control of overactive bladder symptoms and dissatisfaction with same."

"The fact that a relatively shorter versus a longer period of exposure to the most commonly prescribed anti-muscarinic made no difference as to long-term adherence is a bit surprising but not unexpected," he said by email. "The authors do note contributing variables that lead to patient dissatisfaction and need for re-exposure, including those with significant severity of symptoms and physical limitations."

"The message is that the condition is a chronic condition, with variability of symptoms, and that patients need to be given appropriate and reasonable expectations for treatment benefit. The goal is symptomatic amelioration, not necessarily cure," he concluded.

Dr. Fara Bellows, a urologist with The Ohio State University Wexner Medical Center in Columbus, said in an email to Reuters Health, "We already know that approximately 50% of overactive bladder cases spontaneously resolve over time; thus, it is common to see that regardless of length of treatment, some cases require continued treatment, while others don't."

"The study is underpowered with a small sample size, and over a third of patients did not complete treatment," she noted. "The response rate was also quite low, so I suspect that if the patients who dropped out actually stayed in the study, then the response rate would actually have been documented as lower."

"I generally consider overactive bladder a chronic condition, so I encourage my patients to take the medication as long as they can tolerate it," she said. "If it improves their quality of life and they are doing well with it, then there should be little to no reason to discontinue, aside from cost."

Dr. Tanaka Dune, a urogynecologist and assistant professor at NewYork-Presbyterian/Weill Cornell Medicine in New York City, told Reuters Health, "I frequently tell women that taking anticholinergics does not cure the underlying overactive bladder in that if they were to stop the medication, often the symptoms come back and the medications have to be restarted."

"I do find that women who report major bothersome symptoms do tend to continue the medication," she said by email. "We know that compliance with taking medications for overactive bladder generally decreases with time. The study stopped at six months only because the authors needed to choose a reasonable end date for them."

Like Dr. Bellows, Dr. Dune noted, "Typically, the drug is prescribed as a routine medication the patient can take, even for life. There is no set stop date for the medication as long as the patient tolerates it, reports minimal side effects and the medication is working for their symptoms."

Dr. Lin did not respond to requests for a comment.

SOURCE: http://bit.ly/2vxm8rO

Maturitas 2019.