Abstract
Purpose
Previous studies have included a limited number of randomized controlled trials (RCTs) and compared limited parameters after treatment with imidafenacin and other anticholinergic drugs (ADs) for overactive bladder syndrome (OAB), and controversy about the superiority of these ADs still remains. We aim to update the evidence and provide better clinical guidance.
Methods
A systematic search of PubMed, Embase, ClinicalTrial.gov and Cochrane Library Central Register of Controlled Trials was conducted from January 2007 to April 2019. Meta-analysis of all published RCTs comparing imidafenacin with other ADs in patients with OAB was performed. The primary outcomes were the changes in OAB symptoms and OAB symptom score (OABSS). Secondary outcomes included adverse events (AEs) and the dropout rate related to AEs.
Results
A total of 6 studies including 7 RCTs involving 1430 patients with mean follow-up of 23.43 weeks were included. All ADs improved OAB symptoms. Regarding efficacy, these drugs had similar efficacy in voids, urgency episodes, urgency incontinence episodes, incontinence episodes and OABSS. However, imidafenacin performed better in the reduction of nocturia episodes (MD = –0.24, 95% CI –0.44 to –0.04, P = 0.02). Moreover, imidafenacin was associated with a statistically lower dry mouth rate (RR = 0.87, 95% CI 0.75–1.00, P = 0.04), lower constipation rate (RR = 0.68, 95% CI 0.50–0.93, P = 0.01) and lower AE-related withdrawal rate (RR = 0.51, 95% CI 0.29–0.89, P = 0.02). There was no significant difference in terms of other complications.
Conclusions
In conclusion, imidafenacin was comparable to other ADs in the treatment of OAB. Moreover, imidafenacin presented a lower dry mouth rate, lower constipation rate and higher adherence and persistence.
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Abbreviations
- OAB:
-
overactive bladder syndrome
- OABSS:
-
Overactive bladder symptom score
- RCT:
-
randomized controlled trials
- AE:
-
adverse event
- AD:
-
anticholinergic drug
- PVR:
-
postvoid residual volume
- UTI:
-
urinary tract infection
- ROB:
-
risk of bias
- MD:
-
mean difference
- RR:
-
relative risk
- CI:
-
confidential interval
- QOL:
-
quality of life
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Funding
This study was funded by the National Natural Science Fund of China(grant nos. 81770673) and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (grant nos.ZY2017310).
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J-P Wu, L Peng and X Zeng: data collection, data analysis, manuscript writing; H Shen, H Li: data collection and management; J-P Wu and D-Y Luo: protocol/project development.
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Wu, JP., Peng, L., Zeng, X. et al. Is imidafenacin an alternative to current antimuscarinic drugs for patients with overactive bladder syndrome?. Int Urogynecol J 32, 1117–1127 (2021). https://doi.org/10.1007/s00192-020-04329-x
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DOI: https://doi.org/10.1007/s00192-020-04329-x