Long-term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity.

Details

Serval ID
serval:BIB_629BF86F1E49
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Long-term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity.
Journal
Neurourology and urodynamics
Author(s)
Joussain C., Popoff M., Phé V., Even A., Bosset P.O., Pottier S., Falcou L., Levy J., Vaugier I., Chartier Kastler E., Schurch B., Denys P.
ISSN
1520-6777 (Electronic)
ISSN-L
0733-2467
Publication state
Published
Issued date
02/2018
Peer-reviewed
Oui
Volume
37
Number
2
Pages
799-806
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Aims of this study were to assess the long-term outcomes of Intradetrusor injection of OnabotulinumtoxinA (Botox® injection) associated with clean intermittent-catheterization (CIC) for the treatment of neurogenic detrusor overactivity (NDO) and to identify risk factors for failure.
Neurological patients with NDO using CIC who had received Botox® injections between January 2001 and September 2013 were included. Clinical, urodynamic and radiological data were recorded. Primary endpoint was failure and withdrawal rates after 3, 5, and 7 years of management. Survival curves of withdrawals and failures of treatment were calculated with a 95-confidence interval using the Kaplan-Meier method. Risk factors for failure were determined with univariate analysis and multivariate analysis using Cox model.
Overall, 292 patients, mean age of 40 ± 13, 6 years, were included. Overall, 219 patients (80.6%; IC95% [76.3-85.4%]) were still treated with Botox® injections after 3 years, 128 (71.1%; IC95% [65.7%, 76.9%]) after 5 years, and 58 (60.8%, IC95% [54.0%, 68.4%]) after 7 years. Failure rate was 12.6% (IC95% [8.6-16.5%]) after 3 years, 22.2% (IC95% [16.6-27.3%]) after 5 years, and 28.9% (IC95% [21.9%; 35.3%]) after 7 years of follow-up. Withdrawal rate after 7 years of follow-up was 11.3% (n = 33/292). Severe NDO at baseline appears to be a significant risk factor for failure.
This study confirms long-term efficacy and tolerance of Botox® injection in patients with NDO using CIC. Long-term failure and withdrawal rates remain low but significant, and need to be managed.
Keywords
Administration, Intravesical, Adult, Botulinum Toxins, Type A/administration & dosage, Botulinum Toxins, Type A/therapeutic use, Female, Humans, Injections, Intermittent Urethral Catheterization, Kaplan-Meier Estimate, Male, Middle Aged, Muscle, Smooth, Retrospective Studies, Risk Factors, Survival Analysis, Treatment Failure, Urinary Bladder, Neurogenic/drug therapy, Urinary Bladder, Overactive/drug therapy, Urodynamics, botulinum toxin, intermittent urethral catheterization, long-term care, neurogenic, risk factors, type A, urinary bladder
Pubmed
Web of science
Create date
28/08/2017 10:38
Last modification date
24/09/2019 6:11
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