Drugs can help relieve urinary incontinence in women, but the benefit is small and side effects can lead to discontinuation
of treatment, according to a new study.
Researchers performed a systematic review to examine the safety
and efficacy of drugs available in the U.S. for urgency urinary
incontinence in women. MEDLINE and the Cochrane Central
Register of Controlled Trials were searched from 1966 to November
2011 for published randomized, controlled English-language
trials that examined efficacy and quality of life. Clinically important
improvement was defined as a reduction of 50% or more in
frequency of urinary incontinence, while harms were defined as the
totality of all possible adverse consequences of an
intervention. The study was funded by the Agency for Healthcare Research
and Quality and was published early online April 9 by Annals of Internal Medicine.
A
total of 94 trials were included in the study. In pooled analyses,
continence rates per 1,000 women treated were 130 (95%
CI, 58 to 202) with fesoterodine, 85 (95% CI, 40 to 129) with
tolterodine, 114 (95% CI, 64 to 163) with oxybutynin, 107 (95%
CI, 58 to 156) with solifenacin and 114 (95% CI, 83 to 144)
with trospium. Rates of discontinuation due to adverse effects
per 1,000 women treated were 31 (95% CI, 10 to 56) with
fesoterodine, 63 (95% CI, 12 to 127) with oxybutynin, 18 (95% CI,
4 to 33) with trospium and 13 (95% CI, 1 to 26) with
solifenacin.
The authors acknowledged that reporting bias may have affected
their study and that evidence was limited or insufficient in
some areas. However, they concluded that benefits from drug
treatment of urgency urinary incontinence are small and that
discontinuation
of treatment because of side effects is common. "Since all drugs for urgency [urinary incontinence] have comparable effectiveness, therapeutic choices should consider the
harms profile, and women should be informed about all possible adverse effects," the authors noted.
Source: www.acpinternist.org
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