Abstract
Objective
This technical update addendum reviews success rates and comparative evidence of the
anticholinergic fesoterodine, as well as mechanism of action, safety profile, success
rates, and comparative evidence of the β3 agonist mirabegron in the treatment of non-neurogenic
overactive bladder syndrome (OAB). This adds to OAB pharmacotherapy recommendations
initially published in 2012.
Intended Users
Residents and other trainees, primary care practitioners, gynaecologists, urologists,
urogynaecologists, and other health care providers who assess, counsel, and treat
women with OAB.
Target Population
Adult women with symptomatic OAB.
Options
This addition relates to fesoterodine, mirabegron, and anticholinergic-β3 agonist
combination pharmacotherapy.
Outcomes
The outcomes of interest are clinical efficacy of fesoterodine compared with no treatment
or other OAB therapies; mechanism of action and safety profile of mirabegron, clinical
efficacy of mirabegron compared to no treatment or other OAB therapies; clinical efficacy
of anticholinergic-β3 agonist combination pharmacotherapy for OAB.
Evidence
PubMed, Medline, and the Cochrane Database were searched using the key words “fesoterodine”
and “mirabegron.” Results were restricted to English or French and human clinical
and pharmacological research. Animal research and clinical studies including only
male participants were excluded. Articles were included until the end of December
2016. Grey literature was not searched. Clinical practice guidelines, guidelines of
specialty societies, and systematic reviews were included. RCTs and observational
studies were included when evidence for the outcome of interest or in the target population
was not available from systematic reviews. New studies not yet included in systematic
reviews were also included. References of included articles were also searched to
ensure comprehensive inclusion of relevant literature.
Values
The content and recommendations were drafted and agreed upon by the principal author,
as well as members of the Urogynaecology Committee. The Board of the SOGC approved
the final draft for publication. The quality of evidence was rated using the criteria
described in the Grading of Recommendations Assessment, Development and Evaluation
(GRADE) methodology framework. The Summary of Findings is available upon request.
Benefits, Harms, and/or Costs
It is expected that this technical update will benefit patients with OAB by providing
physicians and other interested health care providers with additional options for
and knowledge of safe and effective OAB pharmacotherapy. The benefits clearly outweigh
the potential harms or costs of implementation of this technical update, although
there are no direct harms or costs identified.
Updates
“Evidence will be reviewed 5 years after publication to decide whether all or part
of the document should be updated. However, if important new evidence is published
prior to the 5-year cycle, the review process may be accelerated for a more rapid
update of some recommendations.”
Sponsors
Not applicable.
Recommendations
- 1.Fesoterodine is recommended as a treatment for overactive bladder (Strong, High).
- 2.Dose escalation of fesoterodine is recommended for improved clinical efficacy, as it is associated with significant subjective and objective clinical improvement, both short and long term (Strong, High).
- 3.Fesoterodine is recommended as an anticholinergic of choice for overactive bladder symptoms in elderly and frail elderly (Strong, High).
- 4.Fesoterodine is recommended for overactive bladder symptoms in patients with pre-existing cardiac concerns or cognitive dysfunction (Strong, Moderate).
- 5.Fesoterodine is recommended for nocturnal overactive bladder symptoms to improve sleep quality (Conditional, High).
- 6.Mirabegron is recommended as a treatment for overactive bladder (Conditional, High).
- 7.Mirabegron is recommended for overactive bladder symptoms in patients with intolerable side effects or suboptimal response on anticholinergic therapy (Strong, Moderate).
- 8.Mirabegron may be used in combination with solifenacin 5 mg for overactive bladder symptoms as an alternative to solifenacin 10 mg to decrease anticholinergic side effects of the higher dose solifenacin (Conditional, High).
Key Words
Abbreviations:
CNS (central nervous system), FORTA (Fit fOR The Aged), OAB (overactive bladder syndrome), RCT (randomized control trial)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: October 04, 2017
No. 353, December 2017 (Complements No. #283, November 2012)Footnotes
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
Women have the right and responsibility to make informed decisions about their care in partnership with their health care providers. To facilitate informed choice women should be provided with information and support that is evidence based, culturally appropriate, and tailored to their needs. The values, beliefs, and individual needs of each woman and her family should be sought, and the final decision about the care and treatment options chosen by the woman should be respected.
Identification
Copyright
Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
