OnabotulinumtoxinA for neurogenic detrusor overactivity and dose differences: a systematic review

ABSTRACT

Purpose To evaluate the efficacy and safety of onabotulinumtoxinA for patients with neurogenic detrusor overactivity (NDO). Materials and Methods We searched the Cochrane Library, PUBMED, EMBASE, Chinese Bio-medicine database, China Journal Full-text Database, VIP database, Wanfang database for randomized controlled trials (from inception to September 2012). Two authors independently selected studies, extracted data and assessed the methodological and evidence quality using the Cochrane Risk of Bias Table and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) respectively. Data analysis was performed by RevMan 5.1 and descriptive analysis was employed if necessary. Results Eight studies were selected (n=1879 participants). OnabotulinumtoxinA was more related to urinary tract infection (UTI) (200U OR 1.72, CI 1.18-2.52; 300U OR 1.88, CI 1.31-2.69) versus placebo. Also, OnabotulinumtoxinA was superior to placebo in improving maximum cystometric capacity (MCC) (200U OR 138.80, CI 112.45-165.15; 300U OR 152.09, CI 125.25-178.93) and decreasing maximum detrusor pressure (MDP) (200U MD -29.61, CI -36.52--22.69; 300U MD-28.92, CI -39.59--18.25). However, there were no statistical differences between 200U and 300U onabotulinumtoxinA in UTI (OR 0.84, CI 0.58-1.22), MCC (OR-12.72, CI -43.36-17.92) and MDP (MD 2.21, CI -6.80-11.22). Conclusions OnabotulinumtoxinA may provide superior clinical and urodynamic benefit for populations with NDO. High-quality studies are required for evaluating the optimal dose, long-term application and when to perform repeated injections. .