A novel approach to overactive bladder syndrome treatment

Overactive bladder (OAB) symptoms are among the most bothersome complaints of our elderly patients. They have substantial impact on all aspects of pa-tients' well–being and reduce their quality of life. This condition affects almost 12% of the adult population of Europe. The prevalence is constantly rising with age and reaches 36% in the group of patients above 75 years of age. The incidence of overactivity related incontinence reaches 28.7% and 50% respectively in men and women [1]. Muscarinic receptor antagonists still constitute the mainstay of the OAB pharmacotherapy. The efficacy of different antimuscarinics is comparable; they relieve symptoms partially and their efficacy is at best moderate. The adverse reaction profiles of mus-carinic receptor antagonists used as first line treatment are comparable except for higher oral doses of oxybutynine and propiveryne [2]. The results of clinical trials show really high discon-tinuation rates – from 4% to 31% in 12 weeks observation. Furthermore, 43% to 81% of patients discontinue their treatment within 30 days, according to the medical claims studies [3]. Professor Kosilov and the co–authors, whose paper appeared in this edition of CEJU address the important clinical problem that is safe and effective treatment of the Overactive Bladder Syndrome (OAB) in the elderly [4]. The Vladivostok team describes the placebo controlled study that analyzes the effects of a novel scheme of treatment with anticholinergic agents (combined high dose pulse anticholinergic therapy) in elderly patients with detrusor overactivity related urinary incontinence. The authors used two compounds with antimuscarinic activity, which are currently not being studied as extensively, as those, having different mechanisms of action. The authors observed a reduction of incontinence events (IE) and urgency episodes lasting until the end of the observation in the group assigned to the double pulse treatment arm in both incontinence severity subgroups. Similar reduction of IE and urgency episodes was observed in patients assigned to single pulse treatment arm, but only in the moderate incontinence severity subgroup. Particularly interesting is why the severtiy of symptoms remains reduced, even after treatment cessation. When the subjects are at least in their sixties and the study drug has relatively narrow therapeutic window, the key question is the safety. The study results revealed a low rate of adverse reactions (AR) – below 12% of patients experienced ARs. These ARs were classified as moderate. The authors provide only an overall percentage of episodes. Taking into account the high doses of study …