New Condition: Overactive Bladder

03 Mar New Condition: Overactive Bladder

We are pleased to announce the addition of a new condition to our TreatGx medication decision support software. The Overactive Bladder treatment algorithm can now be accessed by all TreatGx users and includes pharmacotherapy options for adults with overactive bladder, including symptoms of urge urinary incontinence, frequency, and/or urgency. There can be a significant impact on quality of life, which should be considered when deciding on treatment options.

For treatment of overactive bladder, all patients are encouraged to implement non-drug measures such as behavioral therapy (e.g. bladder training and pelvic floor muscle therapy such as Kegel exercises) and/or lifestyle changes. Pharmacotherapy can be combined with these measures if needed.

Once the decision has been made to start a medication, the TreatGx algorithm for Overactive Bladder assists the clinician and patient in personalizing medication therapy options, including:

• Providing dosing information for several treatment options for overactive bladder:
  • Antimuscarinics (anticholinergics): darifenacin, fesoterodine, oxybutynin, propiverine (available in Canada only), solifenacin, tolterodine, and trospium.
  • Beta3-adrenergic agonists: mirabegron, and vibegron (newly approved in the US only).
  • Botulinum toxin A (onabotulinumtoxinA) injection in carefully-selected patients if first-line medications are contraindicated or ineffective.
  • Intravaginal estrogens for post-menopausal patients with vaginal atrophy and overactive bladder.
• Providing personalized dosing and options based on kidney function, liver function, medical history, age, pharmacogenetics, and drug-drug interactions.
• Providing information on the pharmacogenetic impact of CYP2D6 variants for four medications used to treat overactive bladder, from the FDA table of pharmacogenetic associations. [1]

Several recent overactive bladder clinical guidelines and systematic reviews were considered when developing this algorithm, including: the American Urological Association (AUA) 2019 Guideline on overactive bladder in adults [2], the Canadian Urological Association (CUA) 2017 Guideline on overactive bladder in adults [3], the European Association of Urology (EAU) 2020 Guideline on urinary incontinence in adults [4], BMJ Best Practice 2020 Urinary incontinence in women [5], and a systematic review by Hsu et al. 2019 for overactive bladder [6].

References: 

1. US Food and Drug Association:Table of Pharmacogenetic Associations. In:https://wwwfdagov/medical-devices/precision-medicine/table-pharmacogenetic-associations. 2020. 
2. Lightner DJ, Gomelsky A, Souter L, Vasavada SP:Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019.J Urol 2019, 202(3):558-563. 
3. Corcos J, Przydacz M, Campeau L, Gray G, Hickling D, Honeine C, Radomski SB, Stothers L, Wagg A, Lond F:CUA guideline on adult overactive bladder.Can Urol Assoc J 2017, 11(5):E142-e173. 
4. Burkhard FC, Bosch JLHR, Cruz F, Lemack GE, Nambiar AK, Thiruchelvam N, Tubaro A:EAU Guidelines on Urinary Incontinence in Adults. In.: European Association of Urology; 2020.
5. Davila GW, Martin L:Urinary incontinence in women. In:BMJ Best Practice. 2020. 
6. Hsu FC, Weeks CE, Selph SS, Blazina I, Holmes RS, McDonagh MS:Updating the evidence on drugs to treat overactive bladder: a systematic review.Int Urogynecol J 2019, 30(10):1603-1617.