Heterogeneity is evident in multiple areas of clinical medicine. Unfortunately, despite clear evidence of varying expressions of disease and varying responses to treatment, population averages are generally used for patient counseling. Although some areas of clinical care have benefitted from some progress in personalizing prevention, diagnosis, and treatment, most areas, including OAB, have not. For example, there has been insufficient delineation of the heterogeneity of OAB itself, beyond the segregation into “wet” and “dry” OAB. Thus, clinicians are left with fairly “generic” approaches to OAB treatment and patients are provided “average study population” symptoms improvement rates.
This manuscript offers some evidence that there is heterogeneity within the expression of OAB as well as the response to pharmacologic treatment. Despite the modest sample sizes, the signal of variation across patients deserves further study, especially to help clarify which pharmacologic treatment is most likely to improve symptoms for any individual patient. We encourage research teams who are engaged in testing new OAB treatments to collect urobiome samples (following published consensus guidelines1 to help characterize participants from a biologic standpoint – both at baseline and during/following treatment. Targeted treatment may be cost-effective, more effective, and improve patient satisfaction more than a “one size fits all” approach.
The many patients who suffer with OAB need meaningful, cost-effective advances that lead to higher levels of sustained symptoms relief. Perhaps OAB isn’t a chronic condition at all, but instead an unsolved biologic mystery that is highly amenable to targeted therapy. We hope this manuscript stimulates research teams to follow these early clues with the hopes of impactful discoveries that replace unproven dogma with evidence-supported approaches to personalize clinical care. The myriads of affected patients are counting on us!
Written by:
- Linda Brubaker MD, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA
- Alan Wolfe PhD, Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
Reference:
- Brubaker, L., J. F. Gourdine, N. Y. Siddiqui, A. Holland, T. Halverson, R. Limeria, D. Pride, L. Ackerman, C. S. Forster, K. M. Jacobs, K. J. Thomas-White, C. Putonti, Q. Dong, M. Weinstein, E. S. Lukacz, L. Karstens, and A. J. Wolfe. 2021. 'Forming Consensus To Advance Urobiome Research', mSystems, 6: e0137120.