Botulinum formulations show slight outcomes differences

Munich, Germany-A new comparative study showed that the use of intradetrusor injections of abobotulinum toxin A (Dysport) for urinary incontinence due to neurogenic detrusor overactivity (NDO) provided results that were similar to or superior to those seen with onabotulinum toxin A (Botox), depending on the dosage of the latter.

Urinary incontinence due to NDO in adults who have an inadequate response to or are intolerant of anticholinergic therapy has been shown to be responsive to onabotulinum toxin A. Although an increasing number of reports support the efficacy of abobotulinum toxin A for urinary incontinence, few studies have compared the two in NDO patients.

The current retrospective case-control study was carried out by first author Benoit Peyronnet, MD, a urologist at Rennes University Hospital in Rennes, France, and his team of specialists, and was presented at the European Association of Urology annual congress in Munich, Germany. It was subsequently published online in Neurourology and Urodynamics (March 31, 2016 [Epub ahead of print]).

The study included 211 NDO patients who were treated in three consecutives periods of time. The first time period extended from 2004 to 2006 and included the treatment of 80 patients who received onabotulinum toxin, 300 U; the second period was from 2007 to 2011 and included 78 patients who were treated with abobotulinum toxin, 750 U; and the third time period spanned the years 2011 to 2014 and studied 53 patients who received onabotulinum toxin, 200 U.

Study authors compared urodynamic and clinical parameters among the three groups with regard to the first intradetrusor injections of three botulinum toxin formulations. The primary endpoint was the rate of success defined as the combination of urgency, urinary incontinence, and detrusor overactivity resolution.

Next: Success rates compared

Success rates compared

Dr. Peyronnet and his team noted that the success rates were similar-65.4% versus 55.6% (p=0.16)-when comparing combined urgency, urinary incontinence, and detrusor overactivity resolution among patients who received either abobotulinum toxin or onabotulinum toxin (any dose, 200 U or 300 U), respectively (n=133).

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The patients who were treated with abobotulinum toxin, 750 U had a higher success rate when compared to the success rate seen in those patients receiving onabotulinum toxin, 200 U (65.4% vs. 41.5%; p=.007). By contrast, there were similar success rates in the abobotulinum toxin, 750 U, and onabotulinum toxin, 300 U groups (65.4% vs. 65%; p=.91).

However, the investigators noted a trend toward longer time intervals between the first and the second injections in the onabotulinum toxin, 300 U group compared to the abobotulinum toxin, 750 U group (12.4 vs. 9.3 months; p=.09), suggesting a longer duration of action of onabotulinum toxin, 300 U.

“Success rates of abobotulinum toxin 750 U and onabotulinum toxin 300 U were similar but interval between injections tended to be longer with onabotulinum toxin 300 U,” Dr. Peyronnet and colleagues wrote.

Onabotulinum toxin, 200 U treatments were associated with higher complication rates than were seen in onabotulinum toxin, 300 U, and abobotulinum toxin, 750 U patients. These included seven cases of urinary tract infection (13.2%) and one case of fatigue in onabotulinum toxin 200 U patients. Complications in the other two groups affected under 4% of the study patients.

The side effects of anticholinergic therapy have led to poor compliance with long-term use. Fortunately, patients with an unsatisfactory response to anticholinergic therapy no longer need to face invasive surgical interventions. The low complication rates observed in this study seem to bode well for long-term applications of botulinum toxin for NDO.

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