January - February 2015
This Therapeutics Letter questions the claims for newer drugs for overactive bladder. Two previous Therapeutics Letters on drugs for overactive bladder (OAB) had concluded that the antimuscarinic drugs (oxybutynin, tolterodine, darifenacin, solifenacin and trospium) had limited short-term potential symptomatic benefit (NNT = 7) and significant risk of adverse effects (NNH = 5). This Letter compares drugs to one another, including newer drugs introduced since 2007, when the most recent Therapeutics Letter on this topic was published.
The Therapeutics Initiative found that all drugs for overactive bladder have limited short-term potential benefit and appreciable risk of adverse effects. There is insufficient evidence that benefits of long-term treatment outweigh harm for any overactive bladder drug and claims of superiority for any antimuscarinic drug over the others are not warranted due to methodological shortcomings of available RCTs. Furthermore, recent observational studies suggest that all longterm anticholinergic drugs increase risk of dementia.
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