Incontinence Meds: The Debate
A recent government study claiming that drugs for urgency urinary incontinence have limited benefits and annoying adverse effects has drawn fire from advocates of the medications. Tatyana Shamliyan, MD of the University of Minnesota School of Public Health in Minneapolis and co-authors published their report online in Annals of Internal Medicine. In summarizing it, MedPage Today noted that the authors say "there are few data to show that drugs improve quality of life or have differences in comparative efficacy."
"Since all of the drugs for urgency urinary incontinence have comparable effectiveness, therapeutic choices should consider the harms profile, and women should be informed about possible adverse effects," the team wrote. "Benefits from drugs are small, with fewer than 200 cases of continence attributable per 1,000 treated. Compliance rates for prescription drugs are low; discontinuation due to bothersome side effects is common." The drugs represented in the review were fesoterodine (Toviaz), tolterodine (Detrol), oxybutynin, solifenacin (Vesicare), and trospium.
However, Lawrence Lind, MD of North Shore University Hospital in Manhasset, N.Y. said in response to a request for comment from MedPage Today that the study's results contradict his clinical experience. "I have been treating overactive bladder (OAB) for 16 years," Lind, who was not involved in the study, replied. "Many patients have excellent efficacy on anticholinergics. They are a mainstay of treatment, and with 5,000 or more overactive bladder patients in my practice, I can assure readers that the patient response in practice appears much more positive than this study suggests."
In the same vein, Urologist Elizabeth Kavaler, MD of Lenox Hill Hospital in New York City told MedPage Today that a majority of her patients get durable symptomatic relief with medication. "There are women in whom more invasive options need to be considered," Kavaler said, "but this is a small subset of OAB sufferers. Unlike this meta-analysis suggests, most patients are satisfied with the results of the medication."