The Efficacy and Safety of OnabotulinumtoxinA in Treating Idiopathic OAB: A Systematic Review and Meta-Analysis

Aim: We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating idiopathic OAB. Methods: A literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of idiopathic OAB. The search included the following databases: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Results: Eight publications involving a total of 1,320 patients were used in the analysis, including six RCTs that compared onabotulinumtoxinA with placebo. OnabotulinumtoxinA significantly decreased the mean number of urinary incontinence (UI) per day -2.77 versus -1.01 (the standardized mean difference (SMD)=-1.68, 95% CI=-2.06 to -1.31, P<0.00001); the mean number of micturitions per day -1.61 versus -0.87 (SMD=-1.82, 95% CI=-2.61 to -1.02, P<0.00001); maximum cystometric capacity (MCC) 91.39 versus 32.32 (SMD=63.82, 95% CI=38.14 to 89.50, P<0.00001) and volume voided 44.29 versus 7.36 (SMD=33.05, 95% CI=22.45 to 43.66, P<0.00001) versus placebo and 29.20% versus 7.95% of patients became incontinence-free (odds ratio [OR]=4.89, 95% confidence interval [CI]=3.11 to 7.70, P<0.00001). Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with complications resulting from postvoid residuals (PVR; P<0.00001), urinary tract infections (UTI; P<0.00001) and clean intermittent catheterization (CIC; P<0.00001). Conclusion: This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for idiopathic overactive bladder symptoms with side effects primarily localized to urinary tract. (C) 2014 Wiley Periodicals, Inc.