Behavioral Therapy Noninferior to Drug Therapy in Treating Overactive Bladder Symptoms in Patients With PD
Behavioral therapy is noninferior to drug therapy in improving overactive bladder (OAB) symptoms in patients with Parkinson disease (PD), according to a recent study published in JAMA Neurology.
“Published clinical guidelines in PD currently recommend solifenacin therapy as possibly useful for symptoms of OAB and do not mention behavioral therapy as an option,” wrote first author Camille P. Vaughan, MD, MS, Birmingham/Atlanta Geriatric Research Education and Clinical Center, US Department of Veterans Affairs, Atlanta, Georgia, and study coauthors. “This study builds on the emerging literature suggesting behavioral therapy may have utility as an initial therapy for the most common urinary symptoms affecting persons with PD.”
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The randomized noninferiority trial included 77 patients with PD who had clinically significant urinary symptom frequency, indicated by an International Consultation on Incontinence Questionnaire OAB module (ICIQ-OAB) symptom score of 7 or higher. Participants were randomized to receive either 5 mg of solifenacin once daily (n = 41) or to participate in a pelvic floor muscle exercise (PFME)–based behavioral therapy program (n = 36) over a 12-week period. ICIQ-OAB scores were measured at baseline (mean [SD], drug, 9.1 [1.7]; behavioral, 8.5 [1.4]) and at week 12 to determine how each treatment affected OAB symptoms.
At week 12, researchers observed a significant improvement in OAB symptoms in both the drug and behavioral therapy groups (mean [SD] score, drug, 5.8 [2.4]; behavioral, 5.5 [2.0]), and both groups were within the a priori noninferiority margin of 15%. These OAB symptom reductions were also associated with reductions in bother and improvement in quality of life (QOL).
The researchers also assessed adverse events every 2 weeks for 8 weeks and again at 12 weeks throughout the treatment period. At 12 weeks, treatment-emergent adverse events, including dry mouth and falls, were more commonly reported in the drug therapy group.
“Given the potential adverse effects and burden of drug therapy, these results suggest behavioral therapy may be a suitable initial treatment approach, even among persons with PD and mild cognitive dysfunction,” wrote the authors.
The study was limited by its mostly male sample size and short-term follow-up, though the researchers note that the study’s duration was “typical of many previous behavioral and drug trials for urinary symptoms.” The authors suggest that future studies should further explore the baseline factors that may impact treatment response and the effectiveness of combination drug and behavioral therapy.
