The Best Drug Therapies for Urgency Urinary Incontinence

Appropriate treatment of urgency urinary incontinence (UI) is largely dependent on the severity of symptoms and how much they interfere with one’s quality of life. Medication, retraining, and surgery are the 3 main treatment approaches for urge incontinence. In a new systematic review, researchers studied the benefits and harms of pharmacological therapies for urge incontinence in women.¹ The results are consistent with those of other similar studies, according to the authors.

Study findings showed that when compared with placebo, medications are strongly associated with an increase in the rates of continence and clinically important improvement in UI symptoms.¹ However, the available medications provide only limited effectiveness and the overall benefits are small. For every 1000 women treated with medication, fewer than 200 achieve continence. Of significance is that discontinuation rates were higher for certain drugs, suggesting that medication choice should be based on an agent’s adverse effect profile since the benefits of all urgency UI medications are similar (Table).

Poor adherence to UI treatments is a significant problem. More than 50% of patients stop taking UI medications after 1 year.² Most patients discontinue treatment because of adverse effects. Solifenacin, at a dose of 5 mg, is associated with the lowest rates of discontinuation.² Solifenacin is also often beneficial to women whose previous treatments have failed, but dose increases provide no benefit.¹ Oxybutynin, trospium, and darifenacin were better for improving UI symptoms in older women. Trospium was the best treatment option for women taking concomitant medications. Patients taking 7 or more concomitant medications were most likely to experience adverse effects. Future research should focus on which factors might improve adherence rates.

Pertinent Point:
- Treatment choice should be based more on the medication’s adverse effects profile, because the benefit profiles of all medications for urgency UI are similar.

References:

1. Shamliyan T, Wyman JF, Ramakrishnan R, et al. Benefits and harms of pharmacologic treatment for urinary incontinence in women. Ann Intern Med. 2012;156:861-874.
2. Cordozo L, Thorpe A, Warner J, Sidhu M. The cost-effectiveness of solifenacin vs fesoterodine, oxybutynin immediate-release, propiverine, tolterodine extended-release and tolterodine immediate-release in the treatment of patients with overactive bladder in the UK National Health Service. BJU Int. 2010;106:506-514.