TY - JOUR
T1 - Combination Therapy for Bladder Dysfunction in Patients with Neurogenic Detrusor Overactivity
AU - Nemirovsky, Amy
AU - Malik, Rena D.
AU - Zimmern, Philippe
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Purpose of Review: Neurogenic bladder is a common condition and top health priority present in 20–70% of patients with neurologic diseases including multiple sclerosis (MS), Parkinson’s disease (PD), spinal cord injury (SCI), and cerebrovascular accidents (CVA). Current gold-standard medications for overactive bladder (OAB), such as anti-muscarinics, have undesirable side effects, or have limited data in neurogenic patients. Combining therapy for urinary urge incontinence (UUI) has shown the potential to increase efficacy while maintaining or improving tolerability of treatment. Our objective was to review and synthesize recent combination therapy studies for UUI in patients with neurogenic detrusor overactivity (NDO). Recent Findings: Non-pharmacologic and pharmacologic combination therapies have been investigated for UUI in patients with NDO. Adding intravaginal neuromuscular electrical stimulation (IVES) or transcutaneous tibial stimulation (TTNS) may not be superior to pelvic floor muscle training (PFMT) on its own. Recent studies on dual therapies have focused on combining drugs with different mechanisms. In adults, a combination of desmopressin with mirabegron showed superior efficacy compared to either drug alone or solifenacin. In children, combination studies have focused on adding gabapentin to drug regimens with promising safety and efficacy. Overall, there are few combination therapy trials for OAB in neurogenic patients compared to those in patients with idiopathic OAB. Summary: There is an unmet medical need for combination therapies in patients with UUI due to neurogenic bladder. It is important to gather practice patterns and encourage providers to share their experiences. In addition, more rigorous clinical studies are needed to explore new combinations.
AB - Purpose of Review: Neurogenic bladder is a common condition and top health priority present in 20–70% of patients with neurologic diseases including multiple sclerosis (MS), Parkinson’s disease (PD), spinal cord injury (SCI), and cerebrovascular accidents (CVA). Current gold-standard medications for overactive bladder (OAB), such as anti-muscarinics, have undesirable side effects, or have limited data in neurogenic patients. Combining therapy for urinary urge incontinence (UUI) has shown the potential to increase efficacy while maintaining or improving tolerability of treatment. Our objective was to review and synthesize recent combination therapy studies for UUI in patients with neurogenic detrusor overactivity (NDO). Recent Findings: Non-pharmacologic and pharmacologic combination therapies have been investigated for UUI in patients with NDO. Adding intravaginal neuromuscular electrical stimulation (IVES) or transcutaneous tibial stimulation (TTNS) may not be superior to pelvic floor muscle training (PFMT) on its own. Recent studies on dual therapies have focused on combining drugs with different mechanisms. In adults, a combination of desmopressin with mirabegron showed superior efficacy compared to either drug alone or solifenacin. In children, combination studies have focused on adding gabapentin to drug regimens with promising safety and efficacy. Overall, there are few combination therapy trials for OAB in neurogenic patients compared to those in patients with idiopathic OAB. Summary: There is an unmet medical need for combination therapies in patients with UUI due to neurogenic bladder. It is important to gather practice patterns and encourage providers to share their experiences. In addition, more rigorous clinical studies are needed to explore new combinations.
KW - Combination therapy
KW - Dual therapy
KW - Mirabegron
KW - Muscarinic antagonists
KW - Neurogenic bladder
KW - Urge urinary incontinence
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U2 - 10.1007/s11884-019-00534-7
DO - 10.1007/s11884-019-00534-7
M3 - Review article
AN - SCOPUS:85074692062
SN - 1931-7212
VL - 14
SP - 288
EP - 293
JO - Current Bladder Dysfunction Reports
JF - Current Bladder Dysfunction Reports
IS - 4
ER -