Female UrologyRepeated Injections of Botulinum Toxin-A for Idiopathic Detrusor Overactivity
Section snippets
Patient Population; Inclusion/Exclusion Criteria
Patients aged 18-80 years of either sex with OAB symptoms for ≥6 months and with IDO refractory to anticholinergics were recruited for a randomized, double-blind, placebo-controlled trial, commencing in 2004. A total of 34 patients were included and the results of this trial have been published previously.3 Currently, 20 patients from this cohort have requested and received at least 1 repeat injection. Figure 1 demonstrates the current status of each patient and describes their reasons for
Results
The mean age of the 20 patients receiving a second injection was 47 years (24-74). The group consisted of 6 males and 14 females. Complete urodynamic data were available for 16 of 20 after a single repeat injection and for 8 of 9 patients who went on to have a third injection. Significant increases in MCC and BC were observed with significant decreases in MDP after the first, second (n = 16), and third (n = 8) injections as compared with baseline (see Table 1).
Comparison of injections 1 and 2
Comment
Our data demonstrate that repeated BTX-A injections seem to be as equally efficacious as the first injection. We have shown that they improve OAB symptoms, urodynamic parameters, and most importantly QoL of IDO patients in a reproducible manner after each injection. Urodynamic data were collected after 3 injections but then stopped as we felt the data were not significantly different between injections and we did not want to subject patients to any further instrumentation.
As far as we are
Conclusions
BTX-A appears to be effective and safe after repeated administration in patients with OAB and IDO. This study reports on favorable outcomes according to the voiding diaries, QoL, and urodynamic assessment with a maximum of 4 years of follow-up. Repeated injections appear equally efficacious, with no emergence of tolerance to treatment seen so far. Certain patients will benefit from dose optimization to improve efficacy or prevent voiding dysfunction. Larger scale studies are warranted to
Acknowledgments
The authors thank Aseptics Unit, Pharmacy Department, Guy's Hospital; Helen Lanka, Anna Bell, Elaine Hazel, Jane Watkins—Urology Nurses; and Jacques Roux, Urology ST3 Trainee.
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Cited by (0)
This study was supported by grants awarded by the British Urological Foundation and an unrestricted educational grant from Allergan, Ltd.
The authors acknowledge financial support from the Department of Health via the National institute for health research (NIHR) comprehensive Biomedical Research Centre award to Guy's and St. Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust.
Arun Sahai and Christopher Dowson are joint first author.
All authors are investigators for Allergan.
The GKT Botulinum Study Group is composed of: Mr Arun Sahai, Mr Mohammad Shamin Khan, Mr Prokar Dasgupta, Mr Christopher Dowson, Dr Norman Gregson, Dr Yue Sun, and Professor Kenneth Smith.