PMID- 27463810
OWN - NLM
STAT- MEDLINE
DCOM- 20170717
LR  - 20220330
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 11
IP  - 7
DP  - 2016
TI  - Efficacy and Safety of OnabotulinumtoxinA in Patients with Neurogenic Detrusor 
      Overactivity: A Systematic Review and Meta-Analysis of Randomized Controlled 
      Trials.
PG  - e0159307
LID - 10.1371/journal.pone.0159307 [doi]
LID - e0159307
AB  - BACKGROUND: Neurogenic detrusor overactivity (NDO) affects the quality of life 
      (QoL) of millions of individuals worldwide. The purpose of this study was to 
      assess the efficacy and safety of onabotulinumtoxinA in patients with NDO using a 
      network meta-analytic approach, which can also quantify and compare the efficacy 
      of onabotulinumtoxinA across different dosages. METHODS: PubMed, EMBASE, and the 
      Controlled Trials Register were searched to identify randomized controlled trials 
      comparing onabotulinumtoxinA to a control for NDO in adult patients. The primary 
      outcome was the mean number of urinary incontinence (UI) episodes per week. 
      Urodynamic parameters included the maximum cystometric capacity (MCC) and the 
      maximum detrusor pressure (MDP). The safety of onabotulinumtoxinA was determined 
      by the incidence of various frequent adverse events (AEs). Two authors extracted 
      data independently, and the statistical analyses were performed using RevMan 
      5.1.0 software. RESULTS: A total of 1,915 patients from six randomized controlled 
      trials were included in this meta-analysis. The onabotulinumtoxinA-treated groups 
      had a significantly decreased mean number of urinary incontinence episodes per 
      week (at week 6) (onabotulinumtoxinA200U: MD: -10.72, 95% CI: -13.4 to -8.04, 
      P<0.00001; 300 U: MD: -11.42, 95% CI: -13.91 to -8.93, P<0.00001), MDP (200 U: 
      MD: -33.46, 95% CI: -39.74 to -27.18, P<0.00001; 300 U: MD: -31.72, 95% CI: 
      -37.69 to -25.75, P<0.00001), and greater increased MCC (200 U: MD: 141.30, 95% 
      CI: 121.28 to 161.32, P<0.00001; 300 U: MD: 151.39, 95% CI: 130.43 to 172.34, 
      P<0.00001) compared to the placebo-treated groups. However, there were no 
      significant differences between the onabotulinumtoxinA-treated groups for the 
      number of weekly UI episodes at 6 weeks (MD: 0.08, 95% CI: -2.57 to 2.73, P = 
      0.95). Similarly, we also observed that there were no significant differences in 
      MCC (MD: -9.97, 95% CI: -33.15 to 13.20, P = 0.40) and MDP (MD: -1.86, 95% CI: 
      -8.09 to 4.37, P = 0.56). Considering the AEs, the onabotulinumtoxinA-treated 
      groups were often associated with more complications, including urinary tract 
      infections (UTIs) (RR: 1.47, 95% CI: 1.29 to 1.67, P<0.00001), urinary retention 
      (RR: 5.58, 95% CI: 3.53 to 8.83, P<0.00001), hematuria (RR: 1.70, 95% CI: 1.01 to 
      2.85, P = 0.05), and muscle weakness (RR: 2.59, 95% CI: 1.36 to 4.91, P = 0.004). 
      CONCLUSIONS: OnabotulinumtoxinA can significantly reduce the frequency of urge 
      urinary incontinence and improve urodynamic parameters (MCC and MDP) in patients 
      with NDO at 6 weeks after treatment. This meta-analysis indicates that 
      onabotulinumtoxinA is effective and safe for treating patients with NDO compared 
      to placebo. Additionally, we did not observe any statistical or clinical 
      differences in efficacy between 300 and 200 U dosages.
FAU - Cheng, Tao
AU  - Cheng T
AD  - The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, 
      China.
FAU - Shuang, Wei-Bing
AU  - Shuang WB
AD  - Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 
      Shanxi, China.
FAU - Jia, Dong-Dong
AU  - Jia DD
AD  - Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
FAU - Zhang, Min
AU  - Zhang M
AD  - The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, 
      China.
FAU - Tong, Xu-Nan
AU  - Tong XN
AD  - The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, 
      China.
FAU - Yang, Wei-Dong
AU  - Yang WD
AD  - Affiliated Hospital of Hebei University, Baoding, Hebei, China.
FAU - Jia, Xu-Ming
AU  - Jia XM
AD  - ShanXi Hospital of Integrated Traditional and Western Medicine, Taiyuan, Shanxi, 
      China.
FAU - Li, Shuo
AU  - Li S
AD  - The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, 
      China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20160727
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - EC 3.4.24.69 (Botulinum Toxins, Type A)
SB  - IM
MH  - Botulinum Toxins, Type A/administration & dosage/*therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Humans
MH  - Male
MH  - *Randomized Controlled Trials as Topic
MH  - Urinary Bladder, Neurogenic/complications/*drug therapy
MH  - Urinary Incontinence/etiology
MH  - Urodynamics
PMC - PMC4963110
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2016/07/28 06:00
MHDA- 2017/07/18 06:00
PMCR- 2016/07/27
CRDT- 2016/07/28 06:00
PHST- 2016/04/08 00:00 [received]
PHST- 2016/06/30 00:00 [accepted]
PHST- 2016/07/28 06:00 [entrez]
PHST- 2016/07/28 06:00 [pubmed]
PHST- 2017/07/18 06:00 [medline]
PHST- 2016/07/27 00:00 [pmc-release]
AID - PONE-D-16-10523 [pii]
AID - 10.1371/journal.pone.0159307 [doi]
PST - epublish
SO  - PLoS One. 2016 Jul 27;11(7):e0159307. doi: 10.1371/journal.pone.0159307. 
      eCollection 2016.