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Patient factors associated with onabotulinum toxin A treatment outcome in women with detrusor overactivity
Author(s) -
Owen Rhian K.,
Abrams Keith R.,
Mayne Christopher,
Slack Mark,
Tincello Douglas G.
Publication year - 2017
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.22948
Subject(s) - medicine , refractory (planetary science) , logistic regression , body mass index , placebo , univariate analysis , randomized controlled trial , urinary system , multivariate analysis , physics , alternative medicine , pathology , astrobiology
Objective To evaluate potential predictors of non‐response to treatment with 200U onabotulinum toxin A (onaBoNTA) in women with refractory detrusor overactivity (DO). Subjects and Methods A secondary analysis of a randomized trial of 200U onaBoNTA versus placebo in women with refractory DO analyzed baseline and 6 week follow‐up data. Univariate and multivariate logistic regression were used to assess demographic factors and baseline clinical parameters on non‐response to treatment defined as 20% or less improvement in urinary urgency and leakage episodes, 10% or less in voiding frequency, not achieving continence, and “no change” or worse on PGI‐I score at 6 weeks. Results One Hundred and twenty‐two women were included. Twenty‐nine (23.8%), 24 (19.7%), and 19 (15.6%) were non‐responders to treatment for urgency, voiding, and leakage episodes, respectively. Fifty‐nine (48.4%) failed to achieve continence, and 28 (23%) were non‐responders on the PGI‐I scale. Smoking status (OR: 2.89 95%CI 1.08, 7.73, P = 0.034) predicted non‐response in urgency episodes, and higher baseline leakage episodes (OR: 1.17 95%CI 1.04, 1.31, P = 0.007) predicted non‐response in achieving continence. Increasing age (OR 1.04, 95%CI 1.0, 1.09, P = 0.063) and body mass index (BMI) (OR 1.07, 95%CI 1.0, 1.16, P = 0.065) showed marginal associations with non‐response on the PGI‐I scale. Conclusion onaBoNTA is an effective treatment for refractory DO, but some fail to respond. For identification of women at risk, our data indicate smokers should be advised of a lesser chance of successful treatment. Older women, those with high BMI and with more severe leakage also have a higher risk of failure. Neurourol. Urodynam. 36:426–431, 2017 . © 2016 Wiley Periodicals, Inc.