Efficacy of 200 IU versus 300 IU botulinum toxin intradetrusor injections in the treatment of neurogenic detrusor overactivity.
Mrs Chloë LEFÈVREa, Dr Loïc LE NORMANDb, Dr Bénédicte REISSa, Prof Brigitte PERROUIN-VERBEa
a CHU Nantes, service de MPR Neurologique, b CHU Nantes, service Urologie
Introduction: Botulinum toxin is a second-line treatment for neurogenic detrusor overactivity (1). The primary objective of this study was to compare the duration of efficacy of botulinum toxin intradetrusor injections (BTI) at a dose of 200 IU (only dosage approved by Marketing Authorisation (MA) in 2011) versus a dose of 300 IU (dose previously used).
Methods: Retrospective review of a prospective cohort of all patients receiving BTI between 24 August 2011 (date of MA) and 1st March 2014 in Nantes, divided into 2 groups. Group 1 had already received BTI at a dose of 300 IU before the MA and group 2 initiated treatment at a dose of 200 IU.
Results: 134 patients were followed for a mean of 4.7 years. In group 1 (n=83), the duration of efficacy was decreased in 49.7% of patients (n=41) at the 200 IU dose and the dose was subsequently increased to 300 IU in these patients. In group 2 (n=51), 37.3% of patients (n=19) failed to respond to a dose of 200 IU and the dose was increased to 300 IU. The mean duration of efficacy of BTI was significantly lower at 200 IU (7.7 months) compared to 300 IU (10.0 months) (p=0.001598). In group 1, a shorter previous duration of efficacy at 300 IU was a prognostic factor for failure of the 200 IU dose (p=0.0004421).
Conclusion: In this study, the duration of efficacy of BTI was longer at a dose of 300 IU than at a dose of 200 IU. In other studies this result was not identified (2), but is worthing discussing because of the benefit to the patient.
(1) de Sèze M, Ruffion A, Haab F, Chartier-Kastler E, Denys P, Game X, Karsenty G, Kerdraon J, Perrouin-Verbe B, Saussine C, Soler JM, Amarenco G. Patient follow-up after botulinum toxin intradetrusor injection. Proposal for management in neurogenic patients. Ann Readapt Med Phys. 2008 May;51(4):315-21.
(2) Ginsberg D, Gousse A, Keppenne V, Sievert KD, Thompson C, Lam W, Brin MF, Jenkins B, Haag-Molkenteller C. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol. 2012 Jun;187(6):2131-9.
Keywords : botulinum toxin A, intradetrusor injections, neurogenic detrusor overactivity, detrusor overactivity, efficacy duration