Skip to main content

Advertisement

SpringerLink
Log in

Advances in Pharmacotherapy for the Treatment of Overactive Bladder

  • Pharmacotherapies and Drug Development/Agents (ES Rovner, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To present the current literature on the pharmacologic management of overactive bladder, including combination therapies, agents still in clinical development, and special considerations related to individuals with cognitive decline, frailty and cardiovascular risk.

Recent Findings

Combination therapy is shown to be more effective than monotherapy, without additional side effects. Preliminary studies on novel treatment methods, including new medications, as well as novel use of established medications, demonstrate improved efficacy with a favorable side effect profile. Investigation into new target pathways may be an area for future pharmacologic development. Special consideration should be given when prescribing anti-muscarinic medication in the frail adult population. Overactive bladder has been associated with frailty and anti-muscarinic medications have been associated with the worsening cognitive decline.

Summary

Combination therapy is a safe and effective alternative to patients with refractory overactive bladder. Caution should be taken in prescribing medications for the frail older adult, and alternative first- and third-line treatments should be considered. Future studies should involve long-term data on safety and outcomes stratified by age with objective measurements of cognition and frailty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics. 2010;29:4–20.

    PubMed  Google Scholar 

  2. Stewart W, Van Rooyen J, Cundiff G, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20:327.

    Article  CAS  Google Scholar 

  3. •• Gormley E, Lightner D, Burgio K et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. April 2019. Updated guidelines for the treatment of OAB.

  4. • Bientinesi R, Sacco E. Managing urinary incontinence in women - a review of new and emerging pharmacotherapy. Expert Opin Pharmacother. 2018;19:1989–97. This review discusses pharmaceuticals currently in development.

    Article  Google Scholar 

  5. Dmochowski RR, Staskin DR, Duchin K, Paborji M, Tremblay TM. Clinical safety, tolerability and efficacy of combination tolterodine/pilocarpine in patients with overactive bladder. Int J Clin Pract. 2014;68(8):986–94.

    Article  CAS  Google Scholar 

  6. Abrams P, Kelleher C, Staskin D, et al. Combination treatment with mirabegron and solifenacin in patients with overactive bladder: efficacy and safety results from a randomised, double-blind, dose-ranging, phase 2 study (Symphony). Eur Urol. 2015;67:577–88.

    Article  CAS  Google Scholar 

  7. •• Gratzke C, van Maaen R, Chapple C, et al. Long-term safety and efficacy of mirabegron and solifenacin in combination compared with monotherapy in patients with overactive bladder: a randomised, multicentre phase 3 study (SYNERGY II). Eur Urol. 2018;74(4):501–9. This trial shows the efficacy and safety of combined anti-muscarinic plus β3-adrenoceptor agonists.

  8. Drake MJ, Chapple C, Esen AA, et al. Efficacy and safety of mirabegron add-on therapy to solifenacin in incontinent overactive bladder patients with an inadequate response to initial 4-week solifenacin monotherapy: a randomised double-blind multicentre phase 3B study (BESIDE). Eur Urol. 2016;70(1):136–45.

    Article  CAS  Google Scholar 

  9. • Vecchioli-Scaldazza C, Morosetti C. Effectiveness and durability of solifenacin versus percutaneous tibial nerve stimulation versus their combination for the treatment of women with overactive bladder syndrome: a randomized controlled study with a follow-up of ten months. Int Braz J Urol. 2018;44(1):102–8. A randomized controlled trial showing improved efficacy with combination PTNS and solifenacin.

    Article  Google Scholar 

  10. Cao Y, Lv J, Zhao C, et al. Cholinergic antagonists combined with electrical stimulation or bladder training treatments for overactive bladder in female adults: a meta-analysis of randomized controlled trials. Clin Drug Investig. 2016 Oct;36(10):801–8.

    Article  CAS  Google Scholar 

  11. Rahn DD, Carberry C, Sanses TV, et al. Vaginal estrogen for genitourinary syndrome of menopause: a systemic review. Obstet Gyncol. 2014 Dec;124:1147–56.

    Article  CAS  Google Scholar 

  12. Ellington, DR., Szychowski, JM, Malek, JM. et al. Combined tolterodine and vaginal estradiol cream for overactive bladder symptoms after randomized single-therapy treatment. Female Pelvic Med Reconstr Surg. 2016;22(4):254-260.

    Article  Google Scholar 

  13. Huang W, Zhong H, Zhou X, et al. Efficacy and safety of Imidafenacin for overactive bladder in adults: a systematic review and meta-analysis. Int Urol Nephrol. 2015;47:457–64.

    Article  CAS  Google Scholar 

  14. Song M, Kim JH, Lee KS, Lee JZ, Oh SJ, Seo JT, et al. The efficacy and tolerability of tarafenacin, a new antimuscarinic acetylcholine receptor M3 antagonist in patients with overactive bladder; randomized, double-blind, placebo-controlled phase 2 study. Int J Clin Pract. 2015;69(2):242–50.

    Article  CAS  Google Scholar 

  15. Di Salvo J, Nagabukuro H, Wickham LA, et al. Pharmacological characterization of a novel beta agonist, vibegron: evaluation of antimuscarinic receptor selectivity for combination therapy for overactive bladder. J Pharmacol Exp Ther. 2017 Feb;360(20):346–55.

    Article  Google Scholar 

  16. Thiagamoorthy G, Giarenis L, Cardozo L. Early investigational β3 adreno-receptor agonists for the management of the overactive bladder syndrome. Expert Opinion on Investigational Drugs. 2015;24(10):1299–306.

    Article  CAS  Google Scholar 

  17. • Chen H, Wang F, Yu Z. Efficacy of Daily Low-dose tadalafil for treating overactive bladder: results of a randomized, double-blind, placebo-controlled trial. Urology. 2017;100:59–64. This trial shows the efficacy of Tadalafil on overactive bladder symptoms.

    Article  Google Scholar 

  18. Monica FZ, De Nucci G. Tadalafil for the treatment of benign prostatic hyperplasia. Expert Opin Pharmacother. 2019;20(8):929–37.

    Article  CAS  Google Scholar 

  19. Gever JR, Soto R, Henningsen RA, Martin RS, Hackos DH, Panicker S, et al. AF-353, a novel, potent and orally bioavailable P2X3/P2X2/3 receptor antagonist. Br J Pharmacol. 2010 Jul;160(6):1387–98.

    Article  CAS  Google Scholar 

  20. Andersson KE. Potential future pharmacological treatment of bladder dysfunction. Basic Clin Pharmacol Toxicol. 2016;119(3):75–85.

    Article  CAS  Google Scholar 

  21. •• Campbell N, Lane K, Gao S, et al. Anticholinergics influence transition from normal cognition to mild cognitive impairment in older adults in primary care. Pharmacotherapy. 2018;38(5):511–9. This study demonstrates the effects of anticholinergic medications on cognitive decline.

    Article  CAS  Google Scholar 

  22. Fox C, Richardson K, Maidment I, et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc. 2011;59:1477–83.

    Article  Google Scholar 

  23. Wagg A, Arumi D, Herschorn S, et al. A pooled analysis of the efficacy of fesoterodine for the treatment of overactive bladder, and the relationship between safety, co-morbidity and polypharmacy in patients aged 65 years or older. Age Ageing. 2017;46(4):620–6.

    PubMed  Google Scholar 

  24. Pratt T, Suskind A. Management of overactive bladder in older women. Curr Urol Rep. 2018;19:92.

    Article  Google Scholar 

  25. •• AUGS Consensus statement. Association of anti-muscarinic medication use and cognition in women with overactive bladder. Female Pelvic Med Reconstr Surg. 2017;23(3):177–8. A report outlining the risk of anti-muscarinic use and cognitive impairment.

    Google Scholar 

  26. •• Suskind A, Quanstrom K, Zhao S, et al. Overactive bladder is strongly associated with frailty in older individuals. Urology. 2017;106:26–31. A study of the association of frailty and OAB diagnosis in older adults.

    Article  Google Scholar 

  27. • Margulis AV, Hallas J, Pottegard A. Comparison of cardiovascular events among treatments for overactive bladder: a Danish nationwide cohort study. Eur J Clin Pharmacol. 2018;74(2):193–9. A study assessing cardiovascular risk in an OAB patient population.

    Article  Google Scholar 

  28. Kallner HK, Christenssonn AA, Elmer C, et al. Safety and efficacy of mirabegron in daily clinical practice: a prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2016;203:167–72.

    Article  CAS  Google Scholar 

  29. Katoh T, Kuwamoto K, Kato D, Kuroishi K. Real-world cardiovascular assessment of patients with overactive bladder and concomitant cardiovascular disease: results of a Japanese post-marketing study. Int J Urol. 2016;23(12):1009–15.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente East Bay-University of California, San Francisco, CA, USA

    Caitlyn E. Painter

  2. Departments of Urology and Gynecology, Obstetrics and Reproductive Sciences, University of San Francisco, Box 0738, 400 Parnassus Avenue, San Francisco, CA, 94143, USA

    Anne M. Suskind

Authors
  1. Caitlyn E. Painter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne M. Suskind
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne M. Suskind.

Ethics declarations

Conflict of Interest

Caitlyn Painter has no conflicts of interest.

Anne Suskind is a consultant for Acoustic Wave Cell Therapy, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Pharmacotherapies and Drug Development/Agents

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Painter, C.E., Suskind, A.M. Advances in Pharmacotherapy for the Treatment of Overactive Bladder. Curr Bladder Dysfunct Rep 14, 377–384 (2019). https://doi.org/10.1007/s11884-019-00562-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-019-00562-3

Keywords

Search

Navigation