Anticholinergic drugs versus placebo for overactive bladder syndrome in adults

Abstract

Around 16% of adults have symptoms of overactive bladder (urgency with frequency and/or urge incontinence). The prevalence increases with age. Anticholinergic drugs are commonly used to treat this condition. To determine the effects of anticholinergic drugs for the treatment of overactive bladder syndrome. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 14 June 2005) and the reference lists of relevant articles. Randomised or quasi‐randomised trials in adults with overactive bladder syndrome that compared an anticholinergic drug with placebo treatment or no treatment. Two reviewer authors independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2005). Sixty ‐one trials, 42 with parallel‐group designs and 19 crossover trials were included (11,956 adults). Most trials were described as double‐blind but were variable in other aspects of quality. The crossover trials did not present data in a way that allowed inclusion in the meta‐analysis. Nine medications were tested: darifenacin; emepronium bromide or carrageenate; oxybutynin; propiverine; propantheline; tolterodine; trospium chloride; and solifenacin. One trial included the newer, slow release formulation of tolterodine. At the end of the treatment period, cure or improvement (relative risk (RR) 1.39, 95%CI 1.28 to 1.51), difference in leakage episodes in 24 hours (weighted mean difference (WMD) ‐0.54; 95% CI ‐0.67 to ‐0.41) and difference in number of voids in 24 hours (WMD ‐0.69; 95%CI ‐0.84 to ‐0.54) were statistically significant favouring medication. Statistically significant but modest sized improvements in quality of life scores were reported in recently completed trials. There was three times the rate of dry mouth in the medication group (RR 3.00 95% CI 2.70 to 3.34) but no statistically significant difference in withdrawal (RR 1.11, 95% CI 0.91 to 1.36). Sensitivity analysis, while limited by small numbers of trials, showed little likelihood that the effects were modified by age, sex, diagnosis, or choice of drug. The use of anticholinergic drugs by people with overactive bladder syndrome results in statistically significant improvements in symptoms. Recent trials suggest that this is associated with modest improvement in quality of life. Dry mouth is a common side effect of therapy but did not seem to have an effect on the numbers of withdrawals. It is not clear whether any benefits are sustained during long‐term treatment or after treatment stops. 抗乙烯膽鹼藥物與安慰劑治療膀胱過動症的比較 大約有16%的成人有膀胱過動的症狀(急尿伴隨頻尿與(或)急迫性尿失禁)。此症狀的盛行率隨著年紀增加。抗乙烯膽鹼藥物常常被用來治療這樣的情形。 評估抗乙烯膽鹼藥物對膀胱過動症治療的效果 我們搜尋了Cochrane資料庫中針對失禁群組的特別登錄試驗(2005年6月14日)與相關文章的參考清單 收納了比較抗乙烯膽鹼藥物相較於安慰劑或是不予治療這三種方式對於成人膀胱過動症的影響的隨機試驗(randomised trials)或半隨機試驗(quasirandomised trials)。 本文2位作者獨立評價文章合格性，試驗品質與摘錄數據。本文中的數據是依照Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2005)一書中所描述的方式來處理 我們共收納了61項試驗(一共11,956個成人)，其中42項是用?行群組模式(parallelgroup designs)，另外19項用的是交叉試驗(crossover trials)。多數試驗聲稱是雙盲的，但在其他部分的品質則有其變異性。交叉試驗並沒有以允許涵蓋統合分析(metaanalysis)的方式來呈現數據。試驗中一共有九種藥物被測試：darifenacin; emepronium bromide或 carrageenate; oxybutynin; propiverine; propantheline; tolterodine; trospium chloride; solifenacin。有一項試驗中包含了一種較新且緩慢釋放配方的tolterodine。在治療期間的最後，下列各項結果在統計上皆明顯傾向於藥物治療：治癒或是改善 (relative risk (RR) 1.39, 95%CI 1.28 to 1.51), 24小時內滲尿次數的差異(weighted mean difference (WMD) −0.54; 95% CI −0.67 to −0.41)與24小時內排尿次數的差異(WMD −0.69; 95%CI −0.84 to −0.54)。最近完成的試驗中描述到雖然統計學上有意義但對於生活品質只有適度的改進。用藥群體相較於其他群體有3倍的比例產生口乾(RR 3.00 95% CI 2.70 to 3.34) 然而在造成參予者退出試驗的數量上沒有明顯統計學上的影響(RR 1.11, 95% CI 0.91 to 1.36)。雖然試驗樣本數少，但敏感性分析顯示年齡、性別、診斷或藥物的選擇對於效果的影響可能性很小。 膀胱過動症的病人用抗乙烯膽鹼藥物治療對於症狀的改善程度有統計學上的意義。 最近的試驗暗示了這樣的差別對於生活品質有適度的改進。口乾是用藥之後一項常見的副作用，但對於參予者退出試驗的數量似乎沒有影響。就長期治療或是停止藥物治療而言，我們並不清楚是否任何的好處會持續下去。 本摘要由中國醫藥大學附設醫院羅嬅泠翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 抗乙烯膽鹼藥物用在有膀胱過動症病人身上。膀胱過動是一種膀胱突然不受控制地收縮而導致尿意並且(或是)漏尿的情況。 在成人中這個狀況是常見的，也被稱為應激性膀胱(irritable bladder)或迫尿肌不穩(detrusor instability)，急尿頻尿症候群(urge or urgencyfrequency...