Overactive bladder is defined by the International Continence Society as a syndrome of urinary frequency and urgency, with or without urge incontinence, appearing in the absence of local pathological factors. Treatment of overactive bladder syndrome first requires a clear diagnosis. In patients with incontinence, multiple forms can be present and it is important to determine which form is dominant. Non-pharmacologic, non-surgical treatment consists of behavioral training (prompted voiding, bladder training, pelvic muscle rehabilitation), transcutaneous electrical nerve stimulation, catheterization, and use of absorbent pads. Pharmacologic treatment for overactive bladder syndrome includes darifenacin, flavoxate hydrochloride, hyoscyamine, oxybutynin chloride, tolterodine tartrate, trospium chloride, scopolamine transdermal, and solifenacin succinate. The purpose of this systematic review is to compare the benefits and harms of drugs used to treat overactive bladder syndrome.

Contents

• Introduction
  • Purpose and Limitations of Systematic Reviews
  • Scope and Key Questions
• Methods
  • Inclusion Criteria
  • Literature Search
  • Study Selection
  • Data Abstraction
  • Validity Assessment
  • Data Synthesis
  • Peer Review and Public Comment
• Results and Discussion
  • Overview
  • Summary
  • Detailed Assessment
  • Key Question 1. For adult patients with urinary urge incontinence/overactive bladder, do anticholinergic drugs differ in effectiveness?
  • Key Question 2. For adult patients with urinary urge incontinence/overactive bladder, do anticholinergic incontinence drugs differ in safety or adverse events?
  • Key Question 3. Are there subgroups of patients based on demographics (age, racial groups, gender), other medications, or comorbidities for which one anticholinergic incontinence drug is more effective or is associated with fewer adverse effects?
• References
• Appendix A. Glossary
• Appendix B. Search strategy
• Appendix C. Methods used to assess quality of studies
• Appendix D. Excluded trials
• Beta Adrenergic Blockers: Evidence Tables

Update 3 Report date: December 2005
Update 2 Report date: May 2005
Update 1 Report date: January 2004
Original Report date: February 2003

The medical literature relating to this topic is scanned periodically. (See http://www.ohsu.edu/ohsuedu/research/policycenter/DERP/about/methods.cfm for scanning process description). Prior versions of this report can be accessed at the DERP website.

The Drug Effectiveness Review Project, made up of 15 organizations including 14 state Medicaid agencies, commissioned and funded this report. These organizations selected the topic of the report and had input into its Key Questions. Content and conclusions of the report were determined entirely by researchers at the Evidence-based Practice Center. The authors of this report have no financial interest in any company that makes or distributes the products reviewed in the report.

Suggested citation:

McDonagh M, Selover D, Santa J, Thakurta S. Drug class review: Agents for overactive bladder. Update 4. http://www.ohsu.edu/drugeffectiveness/reports/final.cfm

The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.