Pharmacological treatment of overactive bladder: a systematic review and meta-analysis

Abstract

Overactive bladder (OAB) is a syndrome characterizes by urinary urgency associated with an increase in daytime urinary frequency and nocturia, with or without urgency incontinence, with no evidence of infection or any other proven disease. Overactive bladder is a condition that negatively interferes with the patient's quality of life, causing depression, anxiety, frustration, low-self esteem and social isolation. The economic impact of this disease is extremely high, considering the diagnosis, the treatment as well as the consequences of the disease, and it tends to increase due to the elevation of life expectancy, since this disease has a higher prevalence with advancing age. Non-pharmacological treatment includes behavioral treatment and the surgical treatments. Behavioral and educational interventions such as limiting irritative bladder agents such as caffeine and alcohol, bladder training and urgency suppression techniques such as pelvic muscles exercises should be part of the therapeutic plan and should be offered initially. These interventions can be combined with pharmacological treatment that is effective in most OAB patients. Surgical treatments are used when pharmacological and behavior treatment fails. There are several safe and effective proven drugs for OAB treatment. Among the pharmacological treatment there are the anticholinergic drugs, which decrease the tone of the detrusor muscle during the filing phase in order to increase bladder capacity. Among the anticholinergic drugs are: oxybutynin, tolterodine, darifenacin and solifenacin. Another class of drugs used for OAB's treatment are ²3 adrenergic drugs that acts directly inhibiting the afferent nerve's activation. Mirabegron is a ²3 adrenergic drug used as an alternative to anticholinergic drugs.The objective of this work is to conduct a systematic review, if possible, followed by meta-analysis comparing the efficacy, adherence and safety of anticholinergic drugs to ²3 adrenergic drug in the treatment of overactive bladder in women, using evidence from randomized controlled clinical trials. The question that is going to be answered in this study is: Is mirabegron more effective, safe and provides more adherence to the OAB treatment in woman compared to the treatment using oxybutynin, tolterodine, darifenacin and solifenacin? The question was structured using the PICOS (Population, Intervention, Control, Outcome, Studies) format, so that the research on the literature will answer it. Only randomized clinical studies that address the use of mirabegron, oxybutynin, darifenacin, tolterodine and solifenacin for the treatment of woman with OAB will be included. It will be considered non-inclusion criteria articles that only analyses pregnant woman, men and children. The Embase, Medline (Pubmed), Cochrane and Lilacs databases are going to be researched. The search is not going to be limited by date. For each study, the following data will be collected through a standardized form: study name, type of study, evidence level, duration, number of included patients, intervention, use indications, clinical situation, clinical outcomes. Other results, details and commentaries will be added if necessary. The articles will be evaluated through the bias risk analysis tool of the Cochrane Collaboration.