Pharmacological interventions for bladder dysfunction in muptiple sclerosis: A systematic literature review
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Date
2016
Authors
Sohor, Katelyn
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Journal ISSN
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Abstract
Background: As many as 75% of multiple sclerosis (MS) patients experience urinary symptoms
during the course of their disease, which can affect many aspects of their daily life.28 Though
effective pharmacological treatment for bladder dysfunction exists, effectiveness in the MS
population has not been adequately reviewed.
Objective: To identify, appraise, and synthesize data to determine efficacy of current
pharmacological treatments for bladder dysfunction, specifically overactive bladder in patients
with MS.
Methods: We searched the Cochrane Database for related systemic reviews, in addition to
searching the following databases for randomized controlled trials: PubMed, Medline [OVID],
EMBASE [OVID], and Cochrane Central Register of Controlled Trials. Databases were searched
from inception date to December 15th, 2015. We used comprehensive Cochrane review search
terms for Medline, EMBASE, and the Cochrane central register. Two reviewers independently
screened titles, abstracts, and full text articles to ensure all studies were randomized controlled
trials, that results for MS patients were presented separately if the study had also included other
patients with bladder dysfunction, and that the outcomes of interest were reported. We included
studies meeting the following criteria: (1) prospective, and randomized controlled trials
conducted in any setting; (2) published in English; (3) conducted on adult patients with a
diagnosis of MS and experiencing bladder dysfunction, as defined by health professional or self
reported symptoms; (4) Studies that examined any pharmacological therapy for treatment of
bladder dysfunction in MS patients.
Results: Of 69 unique abstracts, 6 unique clinical trials met the final inclusion criteria.
Oxybutynin was superior to Propatheline in the domains of mean cystometric capacity, frequency, urgency, nocturia, and incontinence. There were no statistical differences between
Atropine and Oxybutynin in similar domains. Further, Methantheline Bromide, was subjectively
superior to Flavoxate Chloride, and Meladrazine tartrate. OnabotulinumtoxinA was found to be
superior in all measures of bladder dysfunction in comparison with the placebo group. THC and
Cannabinoid trials produced mixed results. A significant reduction in UIEs from baseline in
both treatment groups was found in one trial. The other study did not find significant differences
between treatment and placebo groups in terms of UIEs, however demonstrated significant
improvement on other measures, such as daily voids, and nocturia episodes, and patients
perception of the their bladder condition.
Conclusion: This review suggests that OnabotulinumtoxinA injections, and Anticholinergic
Medications reduce urinary symptoms. Results of studies on Cannabinoids and THC products
are inconsistent. Relative lack of current trials and poor study quality limit conclusions, and
further researcher is warranted.