The recommended treatment algorithm for patients seeking relief from OAB symptoms begins with behavioral modification and/or physical therapy (1st line therapy), followed by medications (2nd line therapy), then botulinum injections, PTNS or SNS (3rd line therapy). Due to the comorbidities, side effects and/or expense of OAB medications, most patients never advance beyond 2nd line therapy and end up either moving back to 1st line therapy or opting out of the treatment pathway altogether. This study was designed to understand why patients who begin OAB therapy do not advance along the treatment pathway.  In addition, we examined the strength of interest for two emerging concepts, wearable neuromodulation systems and implantable tibial nerve devices.

Respondents diagnosed with OAB and who had tried 1st line therapy to help control their symptoms were asked to complete an online survey to understand their awareness, trial/continuance, and satisfaction with currently available OAB treatment options.  The respondents were asked if they were aware of 2nd and 3rd line therapies.  If they tried these therapies, respondents were asked about their satisfaction with them and if they still were using the therapies.  If they were aware, but did not try a particular therapy, they were asked for the reason why. Finally, after reading a brief description, respondents were asked about their likelihood to trial two emerging neuromodulation concepts.

A total of 132 respondents were included in this summary. At the time of the survey, most of the respondents were treating their OAB symptoms by 1st line therapies only (“1st Line Group”), 39%, or opting out of therapy (“No Therapy Group”), 34%.  Only 27% were currently using 2nd line therapies (24%) or 3rd line therapies (3%). See Figure 1.

Of the respondents in the 1st Line Group, 39% had tried 2nd line therapies with only 25% reporting to be satisfied.  Those who did not trial 2nd line therapies cited the risks of side effects, the therapy not being recommended by their doctor and the expense as being the main reasons.

Of the respondents in the No Therapy Group, 42% had tried 2nd line therapies.  When asked about their satisfaction with medications, the respondents were equally split, where 42% stated they were satisfied and 42% were dissatisfied. As for those who did not trial 2nd line therapies, most cited the risk of side effects, the therapy not being recommended by their doctor and a general dislike for medications as being the main reasons.

When provided a description of 3rd line therapies and asked if they were likely to trial the therapy, PTNS had the highest potential trial rate (24% of the 1st Line Group, 26% of the No Therapy Group) followed by botulinum injection (24% of the 1st Line Group, 26% of the No therapy group) then SNS (14% of the 1st Line Group, 15% of the No Therapy Group). 

When groups were provided descriptions of two emerging therapies for OAB, a wearable neuromodulation system (“Wearable”) and an implanted tibial nerve stimulation device (“Implanted”), both preferred the Wearable concept over the Implanted concept. Furthermore, the Wearable was also found to be preferred when compared to all existing 3rd line therapies.

Patients with OAB have limited options for the relief of their symptoms.  Existing 2nd and 3rd line therapies have significant drawbacks. Many patients who enter the treatment pathway often end up using less effective therapies or do nothing. The results of this study indicate that patients are reluctant to try other therapies and instead choose to live with their symptoms (frequent visits to the bathroom, erratic urinary urgency and/or incontinence). Patients indicated that the concept of a non-surgical, drug-free wearable tibial neuromodulation system was the most preferred option.

Patients unable or unwilling to take medications indicated a preference for a  surgery-free option to alleviate their OAB symptoms.  Wearable neuromodulation therapy will allow patients to choose an therapy option that does not require weekly sessions at a clinic, surgery or drugs, and will allow them to manage their treatment at home similar to 1st line therapies.