Anticholinergic drugs versus non-drug active therapies for overactive bladder syndrome in adults

  • Review
  • Intervention

Authors


Abstract

Background

Overactive Bladder Syndrome (OAB) is defined as urgency, with or without urgency incontinence, usually with frequency and nocturia. Pharmacotherapy with anticholinergic drugs is often the first line medical therapy, either alone or as an adjunct to various non-pharmacological therapies. The commonest non-pharmacologic therapies are: bladder training, pelvic floor muscle training with or without biofeedback and electric stimulation to affect detrusor muscle activity.

Objectives

To compare the effects of various anticholinergic drugs with various non-pharmacologic therapies for idiopathic overactive bladder syndrome in adults.

Search methods

We searched the Cochrane Incontinence Group Specialised Register (searched 29 November 2005), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to September 2004), PREMEDLINE, Dissertation Abstracts and the reference lists of relevant articles.

Selection criteria

All randomised, or quasi-randomised, controlled trials of treatment with anticholinergic drugs for overactive bladder syndrome or urge urinary incontinence in adults, in which at least one management arm involved a non-drug new therapy. Trials amongst patients with neuropathic bladder dysfunction were excluded.

Data collection and analysis

Two authors evaluated the trials for appropriateness for inclusion and methodological quality. Three authors were involved in the data extraction. Data extracted was based on predetermined criteria. Data analysis was based on standard statistical approaches used in Cochrane reviews.

Main results

Thirteen trials with 1770 participants were included; all were designed as parallel groups except for one cross-over trial. Trial groups were well matched for baseline characteristics in all trials. Treatment duration was 3 to 12 weeks, with one trial carrying out a follow-up analysis at 24 weeks after starting treatment.

During treatment, symptomatic improvement was more common amongst those on anticholinergic drugs compared with bladder training (RR 0.73; 95% CI 0.59 to 0.90). Combination of anticholinergics with bladder training was also associated with more improvement than bladder training alone but with wide confidence intervals (RR 0.55; 95% 0.32 to 0.93). Similarly, the limited data favoured a combination of anticholinergics with bladder training compared with anticholinergics during treatment but the difference was not statistically significant (RR for improvement 0.81; 95% CI 0.61 to 1.06). For all comparisons, there were too few data to compare symptoms after treatment had ended. Adverse effects, such as dry mouth, were reported by around a third of those taking anticholinergics.

Authors' conclusions

The use of anticholinergic drugs in the management of OAB is well established. During initial treatment there was more symptomatic improvement when (a) anticholinergics were compared with bladder training alone, and (b) anticholinergics combined with bladder training were compared with each modality alone. Anticholinergics have well recognised side effects, such as dry mouth. There were too few data to assess whether or not effects are sustained after stopping treatment.

摘要

背景

罹患膀胱過動症之成人使用抗膽鹼類藥物治療與非藥物治療之比較

膀胱過動症(OAB)定義為急尿感,有或沒有伴隨尿失禁,通常會有頻尿、夜尿等症狀。 抗膽鹼類藥物通常為第一線的選擇藥物,不管是作為單一的治療方式,或者與多樣的非藥物治療的方式一起進行。最通見的非藥物治療方式有:膀胱訓練、骨盆底肌肉的訓練 – 有或沒有伴隨生物回饋及電剌激來影響迫尿肌的活動力。

目標

比較罹患膀胱過動症之成人使用抗膽鹼類藥物治療之效果與採取各種非藥物治療方式的效果。

搜尋策略

我們搜尋了Cochrane Incontinence Group Specialised Register(2005年11月29日)、The Cochrane Central Register of Controlled Trials (CENTRAL)、MEDLINE (1966年1月至2004年9月)、PREMEDLINE、Dissertation Abstracts及相關文獻之參考資料。

選擇標準

以抗膽鹼類藥治療膀胱過動症或壓力性尿失禁之成人的隨機或半隨機試驗,同時試驗中至少有一個實驗組有使用新的非藥物治療。試驗如果含有神經病變造成的膀胱失能之病人則不予收錄。

資料收集與分析

兩位作者評估試驗的案例收納及採用方法之適切性,三位做資料的選取。資料選取是根據上述之選擇標準。資料分析是根據使用於Cochrane reviews的標準分析方法。

主要結論

本文涵蓋了13個試驗包含1770位病人,除了一個是交叉試驗外,其他所有的試驗均設計為平行配對分組,且所有的分組的基本特性都有配對。治療的時間長達3至12週。有一組在開始治療後的24週做分析追蹤。 在治療期間,使用膽鹼類藥物治療的改善程度比膀胱訓綀常見(RR 0.55; 95% CI 0.32至0.93)。 結合抗膽鹼類藥物與膀胱訓綀比單採取膀胱訓綀有效但信賴區間很大(RR 0.73; 95% CI 0.59 to 0.90)。相似地,有限的資料顯示結合抗膽鹼類藥物與膀胱訓綀比單給抗膽鹼類藥物有效,但統計學上沒顯著意義(改善的RR 0.81; 95% C 0.61至1.06)。從各種比較來看,能比較治療結束後的症狀的資料太少了。大約三分之一使用抗膽鹼類藥物的病人出現如口乾等副作用。

作者結論

使用抗膽鹼類藥物來治療膀胱過動症的方法已被確立。不管是(一)使用抗膽鹼類藥物或(二)使用抗膽鹼類藥物配合膀胱訓練,相較於只採行膀胱訓綀等等的物理治療方式都能在治療初期在症狀上產生較多的改善。 抗膽鹼類藥物的副作用如口乾等已被確認出來。至於治療停止後是否能繼續維持效果,由於資料太少所以無法做此評估。

翻譯人

本摘要由中國醫藥大學附設醫院洪瑞鴻翻譯。

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

總結

本文以抗膽鹼類藥物來比較非藥物治療的方式(如膀胱訓練、骨盆底肌肉訓練、或電剌激等)治療膀胱過動症的成人的效果。膀胱過動症定義為急尿感,有或沒有伴隨尿失禁,通常會有頻尿、夜尿等症狀。膀胱過動症是一個重要的健康問題,大約有22萬人為此所苦。男女都有可能罹病,但女性患者較多,且發生率隨年紀增加而上升。病人的經濟及生活品質也會受到嚴重的影響。膀胱過動症的確切的致病過程尚待闡明,而它的治療包括藥物治療以及物理治療。而這兩類治療方式有不同的效果、耐受程度、及副作用。選擇哪一種治療一般而言仍憑經驗為主。這篇回顧文章的目的是檢視上述各種治療方式的證據。13個試驗包含1770位病人被收錄進來,使用抗膽鹼類藥物比只採用膀胱訓綀在症狀上的改善來得常見。且結合抗膽鹼類藥物及膀胱訓綀的治療效果比單採取膀胱訓綀好。使用抗膽鹼類藥物最常見的副作用是口乾,大約出現在三分之一的使用者。這篇回顧文章主要的局限有:收錄進來的試驗一般而言規模不大,品質中等,且沒有長期表現的資料。

Plain language summary

Anticholinergic drugs versus non-drug active therapies (e.g. bladder training, pelvic floor muscle training or electrical stimulation) in the management of over active bladder syndrome in adults.

Over active bladder syndrome is defined as urgency, with or without urge incontinence, usually with frequency and nocturia. It is a major health problem giving an estimated prevalence of over 22 million people affected. It affects both sexes with a female preponderance and its prevalence increases with age. There is also a significant economic and quality of life implication. The exact disease process is yet to be fully elucidated and the treatments are varied from drugs to non-drug modalities, with various efficacy, tolerability and side effect profiles and treatment remains empirical at its best.
The aim of this review is to examine the evidence of the above treatment modalities. Thirteen trials with 1770 participants were included; symptomatic improvement was more common amongst those on an anticholinergic drug compared with bladder training and more symptomatic improvement was seen amongst those on combination therapy with an anticholinergic plus bladder training than bladder training alone. Dry mouth being the main adverse effect was reported in about a third of those taking an anticholinergic drug. The included trials are generally small and of moderate quality, with no data addressing long-term performance are the main limitations of this review.

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