Anticholinergics for urinary symptoms in multiple sclerosis
Editorial Group: Cochrane Multiple Sclerosis Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 29 JAN 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Nicholas RS, Friede T, Hollis S, Young CA. Anticholinergics for urinary symptoms in multiple sclerosis. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD004193. DOI: 10.1002/14651858.CD004193.pub2.
- Publication Status: New
- Published Online: 21 JAN 2009
Multiple Sclerosis (MS) is the commonest physically disabling chronic neurological disease affecting young people. Urinary symptoms are present in about 68% of people with MS but their basis has a number of potential aetiologies that can change with time.
To assess the absolute and comparative efficacy, tolerability and safety of anticholinergic agents in MS patients.
We searched the Cochrane Multiple Sclerosis Group Specialised Trials Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue1), MEDLINE (January 1966 to January 2008), EMBASE (January 1974 to January 2008), supplemented with search of reference lists, personal communication with authors and relevant drug manufacturers.
Randomised trials and cross-over trials (blinded and unblinded) that are either placebo-controlled or comparing two or more treatments.
Data collection and analysis
All four review authors independently assessed eligibility and trial quality, and extracted data. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions.
Our search strategy identified 33 articles of which thirty were excluded. Three single centre trials were included. No details were given regarding randomisation and blinding in the first two trials but side effects were frequent with all treatments.
The first (Hebjorn 1977) was a double blind randomised crossover trial. Thirty four persons with MS received three drugs Methantheline Bromide, Flavoxate Chloride and Meladrazine Tartrate each for 14 days, washout periods were not mentioned. Median volume measurements at the first bladder contraction were statistically significant at a 5% level for Methantheline Bromide only compared to no treatment.
The second (Gajewski 1986) was a prospective parallel group randomised study. Thirty four persons with MS were treated for 6-8 weeks with Oxybutynin (19 subjects) or Propantheline (15 subjects). For frequency, nocturia, urgency, and urge incontinence differences in symptom grade in favour of Oxybutynin were found. However, only for frequency the difference was statistically significant at 5% level.
The third (Fader 2007) was a double blind crossover trial. Sixty four persons with MS received oral Oxybutynin or intravesical Atropine for 14 days. Details of randomisation and blinding were given. There was no significant difference between the two treatments in any efficacy outcome measure. Side effects and QOL scores showed significant differences in favour of atropine.
From the available evidence we cannot advocate the use of anticholinergics in MS.
Plain language summary
Anticholinergic drugs in subjects with Multiple Sclerosis (MS) and urinary symptoms.
Urinary symptoms are very common in people with multiple sclerosis, reflecting the high prevalence of damage to the spinal cord from MS. Symptoms may change with time due to either progression or MS relapses. Common symptoms include frequency, urgency and urinary incontinence.
Adults without neurological problems may experience urgency and incontinence, manifest as so called overactive bladder syndrome or an irritable bladder. While anticholinergic drugs may benefit individuals with overactive bladder syndrome due to their muscle relaxant action, in this review we did not find sufficient evidence to prove benefit from anticholinergic drugs in people with MS. This may reflect the lack of recent research on these medications in people with MS.
In the review we also noted a high rate of adverse effects with more than one in five trial participants having to withdraw from oral treatment. This may reflect a high risk of drug adverse effects in people with CNS damage from multiple sclerosis.
搜尋的範圍包括:Cochrane Multiple Sclerosis Group Specialised Trials Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue1), MEDLINE (January 1966 to January 2008), EMBASE (January 1974 to January 2008)，另外包含文章後面所附的參考資料，和作者的討論，以及相關的藥物資訊。
四個作者分別評估文章的可用性，試驗品質以及擷取數據。數據處理依照Cochrane Handbook for Systematic Reviews of Interventions
在這樣的搜尋條件下，總共找到了33篇文章，其中的三篇單中心試驗被納入分析。前二篇文章並沒有呈現隨機試驗和蒙蔽手法的相關細節，但是治療發生的副作用有清楚提及。第一篇(Hebjorn 1977)是一個雙盲隨機交叉試驗: 總共34位受試者，接受三種藥物治療，分別是Methantheline Bromide, Flavoxate Chloride和Meladrazine Tartrate，各使用14天。沒有提及washout period。造成膀胱初次收縮容積的中位數在接受5%的Methantheline Bromide治療的組別，只和無藥物治療的組別有顯著差異。第二篇(Gajewski 1986)是準平行組隨機研究，34個病人中19位接受Oxybutynin，15位接受Propantheline治療，為期6 – 8周。頻尿，夜尿，尿急，尿失禁等症狀的嚴重程度差異顯示Oxybutynin的治療比較有效。但是只有頻尿的症狀在5%時是有顯著差異的。第三篇(Fader 2007)是雙盲交叉試驗。64個病人接受口服Oxybutynin和膀胱內灌注Atropin治療14天。隨機試驗和蒙蔽的手法細節有呈現在文章中。二種治療的療效並沒有統計上的差別。但副作用以及生活質量評分則有統計上的意義支持atropine作為更好的治療方式。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。