Long-term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity

Aims of this study were to assess the long-term outcomes of Intradetrusor injection of OnabotulinumtoxinA (Botox® injection) associated with clean intermittent-catheterization (CIC) for the treatment of neurogenic detrusor overactivity (NDO) and to identify risk factors for failure.

Neurological patients with NDO using CIC who had received Botox® injections between January 2001 and September 2013 were included. Clinical, urodynamic and radiological data were recorded. Primary endpoint was failure and withdrawal rates after 3, 5, and 7 years of management. Survival curves of withdrawals and failures of treatment were calculated with a 95-confidence interval using the Kaplan-Meier method. Risk factors for failure were determined with univariate analysis and multivariate analysis using Cox model.

Overall, 292 patients, mean age of 40 ± 13, 6 years, were included. Overall, 219 patients (80.6%; IC95% [76.3-85.4%]) were still treated with Botox® injections after 3 years, 128 (71.1%; IC95% [65.7%, 76.9%]) after 5 years, and 58 (60.8%, IC95% [54.0%, 68.4%]) after 7 years. Failure rate was 12.6% (IC95% [8.6-16.5%]) after 3 years, 22.2% (IC95% [16.6-27.3%]) after 5 years, and 28.9% (IC95% [21.9%; 35.3%]) after 7 years of follow-up. Withdrawal rate after 7 years of follow-up was 11.3% (n = 33/292). Severe NDO at baseline appears to be a significant risk factor for failure.

This study confirms long-term efficacy and tolerance of Botox® injection in patients with NDO using CIC. Long-term failure and withdrawal rates remain low but significant, and need to be managed.

Neurourology and urodynamics. 2017 Jul 26 [Epub ahead of print]

Charles Joussain, Mélanie Popoff, Véronique Phé, Alexia Even, Pierre-Olivier Bosset, Sandra Pottier, Laetitia Falcou, Jonathan Levy, Isabelle Vaugier, Emmanuel Chartier Kastler, Brigitte Schurch, Pierre Denys

Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France., Department of Physical Medicine and Rehabilitation, Hôpital Raymond-Poincaré AP-HP, Garches, France., Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris, France., Department of Urology, Hôpital Foch, Suresnes, France., CIC IT Hopital Raymond Poincaré, Garches, France., Department of Clinical Neuroscience, Neuropsychology and Neurorehabilitation Service, Lausanne University Hospital, Lausanne, Switzerland.