Real World Outcomes of Intravesical Onabotulinum Toxin A in Patients with Symptomatic Overactive Bladder

Scrimgeour G1, Aleksejeva K1, Axell R1, Yasmin H1, Nadeem M1, Pakzad M1, Hamid R1, Ockrim J1, Greenwell T1

Research Type

Clinical

Abstract Category

Overactive Bladder

Abstract 235
OAB: Neurotoxin and Imaging
Scientific Podium Short Oral Session 17
On-Demand
Overactive Bladder Urgency Urinary Incontinence Detrusor Overactivity Outcomes Research Methods Retrospective Study
1. Department of Female, Functional and Restorative Urology, University College London Hospital, UK
Presenter
G

Gemma Scrimgeour

Links

Abstract

Hypothesis / aims of study
Prospective randomised trial data shows significant benefit from intravesical Onabotulinum Toxin A (Botox A) in 60% of index patients with symptomatic overactive bladder (OAB). The evidence also suggests that efficacy following the first injection persists throughout subsequent cycles of treatment. However, the available data may not reflect outcomes in all-comers. We aimed to assess the outcomes of treatment with Botox A in real world patients.
Study design, materials and methods
The notes of 418 consecutive patients (median age 61 years, range 22-90 years) with symptomatic OAB refractory to behavioural and medical treatment, and urodynamically-proven idiopathic detrusor overactivity, having their first intravesical Botox A treatment between 1st January 2006 and 31st December 2018, were reviewed. Any patient who had not been seen within the last six months was contacted by telephone. Five patients had inadequate notes and were excluded from assessment. Data was collected on patient demographics, improvement after treatment, continuance of Botox A treatment, number and dosage of repeat treatments and the need for intermittent self-catheterisation (ISC). Improvement was assessed using the Patient Global Impression of Improvement (PGI-I) score following the first Botox injection. This is a validated tool for symptoms of OAB in the form of a single question asking patients to rate their condition after treatment as compared to baseline on a scale of 1 (very much better) to 7 (very much worse). Patients were then stratified based on PGI-I scores into three groups; Good Response (PGI-I scores 1 and 2), Partial Response (PGI-I score 3) and No Response (PGI-I scores of greater than or equal to 4).
Results
A total of 413 patients (285 female, 69%) fulfilled the inclusion criteria, 202 of whom (48.9%) had had previous pelvic surgery. Their outcomes are listed in Table 1.
Interpretation of results
A total of 235 (56.9%) patients had a good response to treatment with Botox A. A partial response was observed in 48 (11.6%) patients. The remaining 130 (31.4%) had no response. Of those in the Good Response group, 174 (74%) were female and in the Partial Response group 32 (66.7%) were female. Although 69% of the total patients were female this was statistically significant. There were no significant differences between age ranges or rates of previous pelvic surgery across the treatment response groups, as shown in Table 1.

A total of 269 patients (65.1%) had more than one Botox A injection; the number of repeat treatments ranged from 1-19. Treatment with Botox A resulted in the need for ISC in 146 (35.4%) patients.
Concluding message
In real world patients (almost half of whom had undergone previous pelvic surgery), Botox A improves symptoms in 68.5%, at the expense of new-onset ISC in 35%. A good response is significantly more likely in women, but does not appear to be dose-dependent.
Figure 1 Table 1
Figure 2 Table 1
Disclosures
Funding Nil Clinical Trial No Subjects Human Ethics not Req'd This was a retrospective records review, therefore not requiring ethical approval Helsinki Yes Informed Consent No
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