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Anticholinergics for urinary symptoms in multiple sclerosis

  • Review
  • Intervention

Authors


Abstract

Background

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.

Objectives

To assess the absolute and comparative efficacy, tolerability and safety of anticholinergic agents in MS patients.

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

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.

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