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Is imidafenacin an alternative to current antimuscarinic drugs for patients with overactive bladder syndrome?

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Abstract

Purpose

Previous studies have included a limited number of randomized controlled trials (RCTs) and compared limited parameters after treatment with imidafenacin and other anticholinergic drugs (ADs) for overactive bladder syndrome (OAB), and controversy about the superiority of these ADs still remains. We aim to update the evidence and provide better clinical guidance.

Methods

A systematic search of PubMed, Embase, ClinicalTrial.gov and Cochrane Library Central Register of Controlled Trials was conducted from January 2007 to April 2019. Meta-analysis of all published RCTs comparing imidafenacin with other ADs in patients with OAB was performed. The primary outcomes were the changes in OAB symptoms and OAB symptom score (OABSS). Secondary outcomes included adverse events (AEs) and the dropout rate related to AEs.

Results

A total of 6 studies including 7 RCTs involving 1430 patients with mean follow-up of 23.43 weeks were included. All ADs improved OAB symptoms. Regarding efficacy, these drugs had similar efficacy in voids, urgency episodes, urgency incontinence episodes, incontinence episodes and OABSS. However, imidafenacin performed better in the reduction of nocturia episodes (MD = –0.24, 95% CI –0.44 to –0.04, P = 0.02). Moreover, imidafenacin was associated with a statistically lower dry mouth rate (RR = 0.87, 95% CI 0.75–1.00, P = 0.04), lower constipation rate (RR = 0.68, 95% CI 0.50–0.93, P = 0.01) and lower AE-related withdrawal rate (RR = 0.51, 95% CI 0.29–0.89, P = 0.02). There was no significant difference in terms of other complications.

Conclusions

In conclusion, imidafenacin was comparable to other ADs in the treatment of OAB. Moreover, imidafenacin presented a lower dry mouth rate, lower constipation rate and higher adherence and persistence.

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Abbreviations

OAB:

overactive bladder syndrome

OABSS:

Overactive bladder symptom score

RCT:

randomized controlled trials

AE:

adverse event

AD:

anticholinergic drug

PVR:

postvoid residual volume

UTI:

urinary tract infection

ROB:

risk of bias

MD:

mean difference

RR:

relative risk

CI:

confidential interval

QOL:

quality of life

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Funding

This study was funded by the National Natural Science Fund of China(grant nos. 81770673) and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (grant nos.ZY2017310).

Author information

Author notes

  1. Jia-Pei Wu, Liao Peng and Xiao Zeng contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China

    Jia-Pei Wu, Liao Peng, Xiao Zeng, Hao Li, Hong Shen & De-Yi Luo

Authors
  1. Jia-Pei Wu
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  2. Liao Peng
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  3. Xiao Zeng
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  4. Hao Li
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  5. Hong Shen
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  6. De-Yi Luo
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Contributions

J-P Wu, L Peng and X Zeng: data collection, data analysis, manuscript writing; H Shen, H Li: data collection and management; J-P Wu and D-Y Luo: protocol/project development.

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Correspondence to De-Yi Luo.

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Wu, JP., Peng, L., Zeng, X. et al. Is imidafenacin an alternative to current antimuscarinic drugs for patients with overactive bladder syndrome?. Int Urogynecol J 32, 1117–1127 (2021). https://doi.org/10.1007/s00192-020-04329-x

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  • DOI: https://doi.org/10.1007/s00192-020-04329-x

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