Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
Eur Urol. 2011 Oct;60(4):784-95. doi: 10.1016/j.eururo.2011.07.001. Epub 2011 Jul 13.
The use of botulinum toxin A (BoNTA) in the treatment of lower urinary tract dysfunction has expanded in recent years and the off-licence usage list includes neurogenic detrusor overactivity (NDO), idiopathic detrusor overactivity (IDO), painful bladder syndrome (PBS), and lower urinary tract symptoms resulting from bladder outflow obstruction (BOO) or detrusor sphincter dyssynergia (DSD). There are two commonly used preparations of BoNTA: Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA).
To compare the reported outcomes of onabotulinumtoxinA and abobotulinumtoxinA in the treatment of NDO, IDO, PBS, DSD, and BOO for adults and children.
We performed a systematic review of the published literature on PubMed, Scopus, and Embase in the English language reporting on outcomes of both BoNTA preparations. Review articles and series with <10 cases were excluded. The articles were graded for level of evidence and conclusions drawn separately for data with higher-level evidence.
There is high-level evidence for the use of onabotulinumtoxinA and abobotulinumtoxinA in adults with NDO but only for abobotulinumtoxinA in children with NDO. Only onabotulinumtoxinA has level 1 evidence supporting its use in IDO, BOO, DSD, and PBS/interstitial cystitis.
We identified good-quality studies that evaluated onabotulinumtoxinA for all the indications described above in adults; such was not the case with abobotulinumtoxinA. Although this does not imply that onabotulinumtoxinA is more effective than abobotulinumtoxinA, it should be a consideration when counselling patients on the use of botulinum toxin in urologic applications. The two preparations should not be used interchangeably, either in terms of predicting outcome or in determining doses to be used.
近年来，肉毒杆菌毒素 A（BoNTA）在治疗下尿路功能障碍中的应用不断扩大，其非处方使用清单包括神经源性逼尿肌过度活动（NDO）、特发性逼尿肌过度活动（IDO）、膀胱疼痛综合征（PBS）以及由膀胱流出道梗阻（BOO）或逼尿肌括约肌协同失调（DSD）引起的下尿路症状。BoNTA 有两种常用制剂：Botox（onabotulinumtoxinA）和 Dysport（abobotulinumtoxinA）。
比较 onabotulinumtoxinA 和 abobotulinumtoxinA 治疗成人和儿童 NDO、IDO、PBS、DSD 和 BOO 的报道结局。
我们在 PubMed、Scopus 和 Embase 上对英文文献进行了系统综述，报道了两种 BoNTA 制剂的结局。排除了综述文章和病例数<10 的系列文章。对文章进行了证据水平分级，并对具有更高证据水平的数据分别得出结论。
有高水平证据支持 onabotulinumtoxinA 和 abobotulinumtoxinA 用于成人 NDO，但只有 abobotulinumtoxinA 用于儿童 NDO。只有 onabotulinumtoxinA 有 1 级证据支持其用于 IDO、BOO、DSD 和 PBS/间质性膀胱炎。
我们确定了评估 onabotulinumtoxinA 用于上述所有成人适应证的高质量研究；但 abobotulinumtoxinA 则不然。这并不意味着 onabotulinumtoxinA 比 abobotulinumtoxinA 更有效，而是在向患者咨询肉毒毒素在泌尿科应用时应考虑的因素。两种制剂在预测结局或确定使用剂量方面都不应互换使用。
