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Drug Class Review: Agents for Overactive Bladder: Final Report Update 4 [Internet]

Drug Class Review: Agents for Overactive Bladder: Final Report Update 4 [Internet]

Drug Class Reviews - Oregon Health & Science University

Version: March 2009

Introduction

Overactive bladder is defined by the International Continence Society as a syndrome of urinary frequency and urgency, with or without urge incontinence, appearing in the absence of local pathological factors. Nocturia is also commonly present. Urinary continence relies heavily upon control and coordination of the smooth muscle found in the wall of the bladder. The effective storage of urine relies on detrusor muscle relaxation, and contraction of internal and external sphincters found within the neck of the bladder while voiding is controlled through the contraction of the bladder’s detrusor muscle and relaxation of its internal and external sphincters. Bladder contraction is mediated via cholinergic muscarinic receptors in bladder smooth muscle. The most common cause of overactive bladder syndrome is detrusor overactivity. Detrusor overactivity may be either idiopathic or neurogenic in origin. A subset of patients with an overactive bladder may complain of urge urinary incontinence, involuntary leakage accompanied by or immediately preceded by urgency.,

Results and Discussion

Previous versions of this report (the original report, Update 1, Update 2, and Update 3) included 128 randomized controlled trials, 3 systematic reviews, and 5 observational studies. For Update 4, our literature search resulted in 512 new citations, of which 335 were from Medline; 3 citations came from the dossier submitted by Novartis. Of these, 44 met the inclusion criteria for this update (4 head-to-head trials, 9 active-control trials, 18 placebo-controlled trials, 11 pooled analyses or extension studies of trials, 1 systematic review, and 1 observational study). Figure 1 shows the study selection process for Update 4. Appendix D lists the excluded studies.

Methods

Adult patients with symptoms of urge incontinence/overactive bladder (urgency, frequency, leakage, dysuria).

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