Comparative Assessment of Efficacy of OnabotulinumtoxinA and Oral Therapies (Anticholinergics and Mirabegron) for Overactive Bladder: A Systematic Review and Network Meta-analysis

To compare the efficacy of onabotulinumtoxinA, mirabegron, and anticholinergics in adults with idiopathic overactive bladder (OAB) using network meta-analysis (NMA).

Information sources were searched for randomized blinded controlled trials, of at least 2 weeks duration, comparing any dose of onabotulinumtoxinA, eligible oral/transdermal anticholinergics, or mirabegron, with each other or placebo, in adults with OAB. Bayesian random-effects models were used to synthesize the results at week 12: NMA for responder analyses and network meta-regression (NMR) for change from baseline analyses. The NMR was used to adjust for differences in baseline severity between studies. Sensitivity analysis, excluding studies considered to be at a high risk of methodological bias, was conducted.

56 randomized trials were included in the networks. For each outcome, results are reported for all licensed treatment doses. For each NMR, results are based on patients with an average number of episodes of the outcome at baseline. After 12 weeks, all treatments are more efficacious than placebo. Patients who received onabotulinumtoxinA (100U) had, on average, the greatest reductions in urinary incontinence episodes (UIE), urgency, and micturition frequency, and the highest odds of achieving decreases of 100% and ≥50% in the daily number of UIE. When comparing onabotulinumtoxinA with other pharmacotherapies, mean differences favoured onabotulinumtoxinA 100U over all comparators for UIE and urgency (credible intervals excluded zero) and all but two of the comparators for micturition frequency. OnabotulinumtoxinA 100U was also associated with higher odds of achieving a 100% and ≥50% decrease in daily UIE than most other licensed treatments in the network. The exclusion of studies with a high risk of bias had little impact on the conclusions.

The results indicate that, after 12 weeks, onabotulinumtoxinA 100U provides greater relief of OAB symptoms compared with most other licensed doses of other pharmacotherapies in the network. This article is protected by copyright. All rights reserved.

BJU international. 2017 Jul 03 [Epub ahead of print]

Marcus J Drake, Victor W Nitti, David A Ginsberg, Benjamin M Brucker, Zsolt Hepp, Rachael McCool, Julie M Glanville, Kelly Fleetwood, Daniel James, Christopher R Chapple

University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, UK., Department of Urology, New York University Langone Medical Center, New York, NY, USA., Department of Urology, USC Institute of Urology, Los Angeles, CA, USA., School of Medicine, New York University Langone Medical Center, New York, NY, USA., Global Health Economics and Outcomes Research, Allergan, Inc., Irvine, CA, USA., York Health Economics Consortium, University of York, York, UK., Quantics, Edinburgh, Scotland, UK., The Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK.