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Future Considerations in Overactive Bladder Pharmacotherapy

Chapter

Abstract

New alternatives for treatment of overactive bladder (OAB) syndrome are continuously being explored. Despite ongoing nonclinical and clinical research, few new principles have evolved. We can expect future new additions to existing drug classes and different combinations of existing options. New antimuscarinics are in development, but we do not know if they offer any advantages to currently available drugs. A new β3-adrenoceptor agonist, vibegron, has an interesting profile and is in clinical development (phase 3). Combinations of agents (e.g., antimuscarinic and β3-adrenoceptor agonists) appear to have advantages in cases not responding to monotherapy. To improve intravesical treatment with botulinum toxins, novel formulations aim at increasing bioavailability at the site of action while decreasing adverse events. These new approaches have been tested in animal models and to some extent in patients. One of the most promising is liposomes containing the toxin. OAB is a filling disorder, and ATP is involved in the generation of afferent impulses. Blocking the ATP pathway by P2X3 receptor antagonists works in animal models of lower urinary tract (LUT) dysfunction, but its clinical effectiveness has not yet been established. Several transient receptor potential (TRP) channels, including TRPV1, TRPV2, TRPV4, TRPM8, and TRPA1, expressed in the LUT, may act as sensors of stretch and/or chemical irritation. Animal studies show that inhibition of some of these pathways can be effective for reduction in bladder activity. Clinical studies of LUT dysfunction are scarce, and the adverse effect of hyperthermia of the first-generation TRPV1 antagonists has delayed development. Nevertheless, TRP channels still may be the most exciting targets for future LUT drugs.

Keywords

Lower urinary tract Bladder Urethra Antimuscarinics β3-adrenoceptor agonists Botulinum toxins Combinations ATP Purinergic receptors TRP channels 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Institute of Laboratory Medicine, Lund UniversityLundSweden

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