Anticholinergic drugs versus other medications for overactive bladder syndrome in adults

 

Abstract

Background

Overactive bladder syndrome is defined as "urgency with or without urge incontinence, usually with frequency and nocturia". It is a common condition with significant economic and quality of life implications. While the condition's pathophysiology remains to be fully elucidated, pharmacotherapy is the main treatment option. Despite uncertainty as to drug treatment of choice, anticholinergics are increasingly being used in primary and secondary care settings. This review compares anticholinergic drugs with other types or classes of drugs for treating overactive bladder syndromes.

Objectives

To compare anticholinergic drugs with other types or classes of drugs for treating overactive bladder symptoms.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 20 December 2006) and the reference lists of relevant articles. No language or other limits were imposed.

Selection criteria

All randomised and quasi-randomised controlled trials comparing anticholinergic drugs with other drugs for the treatment of overactive bladder symptoms. At least one arm of the study used an anticholinergic drug and at least one other arm used a non-anticholinergic drug.

Data collection and analysis

Two reviewers assessed the identified studies for eligibility and methodological quality and independently extracted data from the included studies. Data analysis was performed using RevMan software (version 4.2.8).

Main results

Twelve trials were included in the review. There were seven crossover trials and five parallel group studies. For the comparisons between anticholinergic drugs with tricyclic antidepressants, alpha adrenergic agonists, afferent nerve inhibitors, and calcium channel blocker a single trial was identified for each. Nine trials compared flavoxate with anticholinergics. There was no evidence of a difference in cure rates between anticholinergics and flavoxate. Adverse effects were more frequent in anticholinergic groups versus flavoxate groups (RR 2.28 95% CI 1.45 to 3.56). There was no strong evidence to favour either anticholinergic drugs or the comparators.

Authors' conclusions

Many of the drugs considered in trials in this review are no longer used in clinical practice (and this includes the most commonly tested - flavoxate). There is inadequate evidence as to determine whether any of the available druge are better or worse than anticholinergic medications. Larger randomised controlled trials in clinical settings are required to further establish the role of these medications in the management of overactive bladder syndrome.

 

Plain language summary

Drugs in overactive bladder syndrome

Overactive bladder syndrome is characterised by a need to rush to urinate - urine is passed frequently and there may be incontinence. The main treatment option is drug therapy. The most commonly used drugs are anticholinergics, but these often have side-effects, such as dry mouth. This review sought evidence to compare other types of drugs with anticholinergics. Only a few, small-scale randomised trials were found, many testing drugs that are no longer used clinically. The review found inadequate evidence to assess whether or not available alternative drugs are better or worse than anticholinergics in the management of people with symptoms of overactive bladder syndrome.

 

摘要

背景

抗膽鹼藥物與其他藥物對於成人膀胱過動症之比較

膀胱過動症的定義為:「一種伴隨或未伴隨尿失禁的排尿急迫感，經常也同時存在著頻尿或是夜尿的症狀。」這種狀況與經濟地位和生活品質有著密切的相關性。膀胱過動症的生理病理學仍有待進一步完整的探討，但藥物為目前最主要的治療方法。雖然目前對藥物的種類選擇仍不確定，抗膽鹼藥物在臨床使用上有增加的趨勢。這篇回顧比較了抗膽鹼藥物與其他種類的藥物對於治療膀胱過動症的效果。

目標

比較抗膽鹼藥物與其他種類的藥物對於治療膀胱過動症的效果

搜尋策略

我們搜尋了考科藍失禁群組特別臨床試驗(於2006年12月20日搜尋)和相關文章的參考文獻。沒有任何語言或是其他的限制。

選擇標準

比較抗膽鹼藥物與其他種類的藥物對於治療膀胱過動症的效果，所有隨機控制和幾乎隨機控制的臨床試驗。至少一個群組使用抗膽鹼藥物，至少有另一個群組使用非抗膽鹼藥物。

資料收集與分析

兩位回顧者對於挑選出的研究論文的數據資料，用了合格、適宜的方法以及獨立的方式淬取。數據資料是使用RevMan軟體(4.2.8版本)

主要結論

在這篇回顧中包含了12個臨床試驗。其中包含了7個交叉試驗和5個平行試驗。所做的比較包含了抗膽鹼藥物與三環抗憂鬱劑、甲型擬腎上腺素作用劑、神經傳入抑制劑以及鈣離子通道抑制劑，以上每一種藥物比較都有一個單獨的臨床試驗。有9個試驗比較了優利諾錠與抗膽鹼藥物的效用，並未發現任何在治療上兩者的差別，但抗膽鹼藥物的副作用比優利諾錠來的頻繁(RR 2.28 95%， CI 1.45 至3.56)。並沒有強烈的證據偏向抗膽鹼藥物或是與之比較的藥物。

作者結論

許多在這篇回顧中臨床試驗所使用的藥物現在已經不在臨床上使用(也包含了最常被試驗的優利諾錠)。沒有充足的證據顯示任何現在臨床上可使用的藥物效用比抗膽鹼藥物好或是差。必須要有大型隨機控制臨床試驗去證實這些種類的藥物在膀胱過動症的的角色。

翻譯人

本摘要由中國醫藥大學附設醫院王功錦翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

膀胱過動症的特徵是一種需要排尿的急迫感－尿液頻繁的通過且可能伴隨著失禁。主要的治療方法為藥物治療。最常使用的藥物為抗膽鹼藥物，但經常伴隨著副作用，像是口乾等等。這篇回顧嘗試整理比較抗膽鹼藥物和其他種類藥物的效果。但只有找到一些小型的隨機試驗，而許多試驗所使用的藥物目前也沒有在臨床上使用。這篇回顧無法找到足夠的證據去證明，是否有其他臨床上可使用的藥物，相對於抗膽鹼藥物對於膀胱過動症的病人的治療上有較好或是較差的療效。