title: Anticholinergic drugs for adult neurogenic detrusor overactivity: a systematic review and meta-analysis.
abstract: BACKGROUND
  There is a lack of evidence about the efficacy and safety of anticholinergic drugs and about the optimal anticholinergic drug, if any, for the treatment of adult neurogenic detrusor overactivity (NDO).
  
  
  OBJECTIVE
  Review the current evidence on the efficacy, safety, and tolerability of anticholinergic drugs in the treatment of adult NDO.
  
  
  METHODS
  A literature search was conducted from 1966 to May 2011. Meta-analysis of all published randomised controlled trials (RCTs) comparing anticholinergic drugs with placebo and comparing different types, doses, and routes of administration of anticholinergic drugs, in adults with NDO, was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The primary outcome was patient-reported cure/improvement of overactive bladder symptoms. Secondary outcomes were quality of life (QoL) changes, bladder diary events, urodynamic outcomes, adverse events, and costs to health services.
  
  
  RESULTS
  A total of 960 patients from 16 RCTs with mean follow-up of 3.8 wk were included. Anticholinergic drugs were associated with statistically significantly better patient-reported cure/improvement (risk ratio: 2.80; 95% confidence interval [CI], 1.64 to 4.77), higher maximum cystometric capacity (weighted mean difference [WMD]: 49.49; 95% CI, 15.38 to 84.20), higher volume at first contraction (WMD: 49.92; 95% CI, 20.06 to 79.78), and lower maximum detrusor pressure (WMD: -38.30; 95% CI, -53.17 to -23.43) when compared with placebo. The dry-mouth rates were statistically significantly higher with anticholinergics, with no difference in withdrawals because of adverse events. There was no statistically significant difference in any of the outcomes between oxybutynin and other anticholinergics or among different doses and preparations of anticholinergic drugs. No study reported QoL changes or costs to health services.
  
  
  CONCLUSIONS
  Compared with placebo, anticholinergic treatment in patients with NDO is associated with better patient-reported cure/improvement and significant reduction of maximum detrusor pressure; however, there is a higher incidence of adverse events. None of the anticholinergic drugs or different dosages assessed in this review was superior to another.
authors.affiliation: Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK. priyamadhuvrata@nhs.net
authors.forename: Priya
authors.initials: P
authors.lastname: Madhuvrata
authors.forename: Manju
authors.initials: M
authors.lastname: Singh
authors.forename: Zaid
authors.initials: Z
authors.lastname: Hasafa
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Fattah
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D016017:Odds Ratio; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects* / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology / Q000523:psychology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology / Q000523:psychology; D014563:Urodynamics / Q000187:drug effects
chemical_list: D018680:Cholinergic Antagonists