Lorenz Leitner1, Sharmistha Guggenbühl-Roy2, Stephanie C Knüpfer2, Matthias Walter2, Marc P Schneider3, Jure Tornic2, Ulla Sammer2, Ulrich Mehnert2, Thomas M Kessler4. 1. Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland; Department of Urology, University Hospital Basel, Basel, Switzerland. 2. Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. 3. Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland; Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland. 4. Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. Electronic address: tkessler@gmx.ch.
Abstract
BACKGROUND: Intradetrusor onabotulinumtoxinA (BoNT-ONA) injections have become a well-established therapy for refractory neurogenic detrusor overactivity (NDO). However, little is known about long-term outcome and patients' adherence to this treatment. OBJECTIVE: To assess long-term outcomes of intradetrusor BoNT-ONA injections and patients' adherence to treatment. DESIGN, SETTING, AND PARTICIPANTS: A consecutive series of 52 patients who underwent first intradetrusor BoNT-ONA injections for refractory NDO >10 yr ago were evaluated retrospectively and prospectively at a single university spinal cord injury (SCI) centre. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcome was current neuro-urologic treatment. Secondary outcomes were urodynamic parameters. For data comparison, the paired/unpaired t test, chi-square test, and McNemar test were used. RESULTS AND LIMITATIONS: Mean duration since first intradetrusor BoNT-ONA injections was 12±2 yr. Most patients (61% [32 of 52]) suffered from SCI, 15% (8 of 52) from spina bifida, 14% (7 of 52) from multiple sclerosis (MS), and the remaining (10% [5 of 52]) from other neurologic disorders. Almost 60% (31 of 52) of all patients are continuing with intradetrusor BoNT-ONA injections but only 14% (1 of 7) of the patients with MS. Lack of clinical and/or urodynamic response (21% [11 of 52]) and switching to another treatment (antimuscarinics and/or neuromodulation) despite appropriate BoNT-ONA efficacy (19% [10 of 52]) were the reasons for discontinuation. In patients continuing BoNT-ONA treatment, the positive effect was sustained after repeat injections (p<0.05). CONCLUSIONS: Although intradetrusor BoNT-ONA injections are a highly effective therapy for refractory NDO, approximately 40% of the patients discontinue treatment over time. All prospective neurologic patients should be given this information, and it needs to be considered in the treatment decision-making process. PATIENT SUMMARY: Approximately 60% of the patients treated with intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity continue this therapy long term with good therapeutic effects. STUDY REGISTRATION NUMBER: NCT01293110.
BACKGROUND: Intradetrusor onabotulinumtoxinA (BoNT-ONA) injections have become a well-established therapy for refractory neurogenic detrusor overactivity (NDO). However, little is known about long-term outcome and patients' adherence to this treatment. OBJECTIVE: To assess long-term outcomes of intradetrusor BoNT-ONA injections and patients' adherence to treatment. DESIGN, SETTING, AND PARTICIPANTS: A consecutive series of 52 patients who underwent first intradetrusor BoNT-ONA injections for refractory NDO >10 yr ago were evaluated retrospectively and prospectively at a single university spinal cord injury (SCI) centre. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcome was current neuro-urologic treatment. Secondary outcomes were urodynamic parameters. For data comparison, the paired/unpaired t test, chi-square test, and McNemar test were used. RESULTS AND LIMITATIONS: Mean duration since first intradetrusor BoNT-ONA injections was 12±2 yr. Most patients (61% [32 of 52]) suffered from SCI, 15% (8 of 52) from spina bifida, 14% (7 of 52) from multiple sclerosis (MS), and the remaining (10% [5 of 52]) from other neurologic disorders. Almost 60% (31 of 52) of all patients are continuing with intradetrusor BoNT-ONA injections but only 14% (1 of 7) of the patients with MS. Lack of clinical and/or urodynamic response (21% [11 of 52]) and switching to another treatment (antimuscarinics and/or neuromodulation) despite appropriate BoNT-ONA efficacy (19% [10 of 52]) were the reasons for discontinuation. In patients continuing BoNT-ONA treatment, the positive effect was sustained after repeat injections (p<0.05). CONCLUSIONS: Although intradetrusor BoNT-ONA injections are a highly effective therapy for refractory NDO, approximately 40% of the patients discontinue treatment over time. All prospective neurologicpatients should be given this information, and it needs to be considered in the treatment decision-making process. PATIENT SUMMARY: Approximately 60% of the patients treated with intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity continue this therapy long term with good therapeutic effects. STUDY REGISTRATION NUMBER: NCT01293110.
Authors: Veronika Birkhäuser; Martina D Liechti; Collene E Anderson; Lucas M Bachmann; Sarah Baumann; Michael Baumberger; Lori A Birder; Sander M Botter; Silvan Büeler; Célia D Cruz; Gergely David; Patrick Freund; Susanne Friedl; Oliver Gross; Margret Hund-Georgiadis; Knut Husmann; Xavier Jordan; Miriam Koschorke; Lorenz Leitner; Eugenia Luca; Ulrich Mehnert; Sandra Möhr; Freschta Mohammadzada; Katia Monastyrskaya; Nikolai Pfender; Daniel Pohl; Helen Sadri; Andrea M Sartori; Martin Schubert; Kai Sprengel; Stephanie A Stalder; Jivko Stoyanov; Cornelia Stress; Aurora Tatu; Cécile Tawadros; Stéphanie van der Lely; Jens Wöllner; Veronika Zubler; Armin Curt; Jürgen Pannek; Martin W G Brinkhof; Thomas M Kessler Journal: BMJ Open Date: 2020-08-13 Impact factor: 2.692