Common Overactive Bladder Drugs Rarely Resolve Symptoms

Overactive bladder medications do very little to reduce symptoms in women compared with placebo.

Overactive bladder affects more than 33 million individuals in the United States, or 40% of women and 30% of men.

Patients can pursue several options to control their symptoms, including physical therapy and behavioral adjustments. Medication is often recommended in conjunction with these lifestyle changes, with the most common treatments being anticholinergic agents and beta 3-adrenergic agonists.

However, a recent study suggests these medications do very little to reduce symptoms in women compared with placebo and they hardly ever eradicate symptoms completely.

This meta-analysis published in the June 2015 issue of Obstetrics & Gynecology found the medications administered in a daily dose reduced urge incontinence by 1.73 episodes a day and voids by 2.06 per day. Meanwhile, placebo reduced urge incontinence episodes by 1.06 and voids by 1.2 a day.

The study authors noted no particular agent was more effective than another, which is consistent with guidelines from the American Urological Association that indicate its evaluation of pharmacologic options for overactive bladder “reveal no compelling evidence for differential efficacy across medications.”

As an alternative, Karyn S. Eilber, MD, of the Cedars-Sinai Medical Group, told Medscape she has had success with anticholinergic therapies combined with mirabegron, a FDA-approved drug for overactive bladder. While this represents off-label use, the combination therapy may help further reduce symptoms in patients who are otherwise experiencing low symptom reduction.

Although physicians and pharmacists are aware of the shortcomings of overactive bladder treatment, these findings are still significant. The fact that the medications are only slightly more effective than placebo suggests a treatment regimen that includes anticholinergic therapy may not be worthwhile for some patients.

Beyond efficacy issues, Dr. Eilber added that “some of these medications can be quite pricey,” so recommending them might not be in the best interest of the patient for financial reasons.