Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany.
Int J Urol. 2020 Apr;27(4):289-294. doi: 10.1111/iju.14189. Epub 2020 Feb 8.
This review article discusses the medical need for improved medical treatments of overactive bladder syndrome, and the hurdles and research required to address that need. Currently, few overactive bladder syndrome patients stay on long-term treatment, largely because efficacy expectations are not met, and tolerability is considered insufficient for the chronic treatment of a non-life-threatening condition. Therefore, a medical need exists for improved tolerability and, even more importantly, improved efficacy. It is unlikely that major improvements of efficacy and tolerability can be achieved within the currently approved drug classes. Work in experimental animals suggests that many causes of overactive bladder syndrome exist - each with a distinct pathophysiology. This makes it unlikely that a single medication can address the pathophysiology and treatment needs of all overactive bladder syndrome patients; accordingly, any medication will appear to have only moderate efficacy in the overall group of overactive bladder syndrome patients, even if it fully eliminates symptoms within a subset of patients. It is proposed that only identification of subsets of patients with a defined pathophysiology (and biomarkers thereof) will allow the development and use of targeted treatment that can be highly effective in such subsets.
这篇综述文章讨论了改善膀胱过度活动症治疗方法的医学需求，以及为满足这一需求而需要克服的障碍和开展的研究。目前，很少有膀胱过度活动症患者能坚持长期治疗，主要是因为疗效预期未得到满足，而且对于非危及生命的疾病的慢性治疗，其耐受性被认为不足。因此，存在对改善耐受性的医学需求，更重要的是，还需要改善疗效。在目前批准的药物类别中，不太可能取得疗效和耐受性的重大改善。实验动物的研究表明，膀胱过度活动症存在多种病因——每种病因都有独特的病理生理学。这使得单一药物不太可能解决所有膀胱过度活动症患者的病理生理学和治疗需求；因此，任何药物在整个膀胱过度活动症患者群体中的疗效看起来都只会是中等，即使它能完全消除一部分患者的症状。有人提出，只有确定具有特定病理生理学（及其生物标志物）的患者亚组，才能开发和使用针对这些亚组的靶向治疗，从而在这些亚组中取得高度有效的治疗效果。
