Department of Medical Pharmacology, Istanbul Medipol University, Istanbul, Turkey.
Department of Urology, St. Antonius-Hospital, Gronau, Germany.
Adv Ther. 2022 Jun;39(6):2489-2501. doi: 10.1007/s12325-022-02114-4. Epub 2022 Mar 24.
Unmet expectations are a major cause of perceived treatment failure and discontinuation of treatment. To enable evidence-based counselling of patients on realistic expectations, we determined the chance of patients with overactive bladder becoming free of a given symptom upon treatment with a muscarinic antagonist in a non-interventional setting.
Two non-interventional studies included 1335 and 745 patients, respectively, who received 30 or 45 mg q.d. propiverine ER for 12 weeks. They were monitored for becoming free of urgency, urinary incontinence, frequency, or nocturia. Analyses were also performed in subgroups defined by basal symptom severity, age, and gender. Categorical data are shown as a percentage of the respective population. Continuous data are expressed as means or as median depending on whether the variability was considered to exhibit a normal distribution.
The probability of becoming symptom-free was largest for incontinence and frequency (about 50%), but lesser for urgency (about 20%) and nocturia (about 10%). Greater basal severity of a symptom reduced the chance to become free of that symptom upon treatment, but the chance to become free of incontinence and frequency was still considerable. Age and gender had only minor if any effects on the chance of becoming symptom-free. These findings are in line with those of a limited number of randomized controlled trials.
These data provide an evidence base for the counselling of patients with overactive bladder on realistic expectations of treatment outcomes. We propose that realistic expectations can lead to greater long-term adherence.
未满足的期望是导致治疗失败和治疗中断的主要原因。为了能够为患者提供基于证据的咨询，让他们对治疗结果抱有合理的期望，我们在非干预性环境下确定了使用抗毒蕈碱药物治疗膀胱过度活动症患者，使患者摆脱特定症状的可能性。
两项非干预性研究分别纳入了 1335 例和 745 例患者，他们分别接受了 30 或 45mg 每日一次琥珀酸索利那新控释片治疗 12 周。监测他们是否能摆脱尿急、尿失禁、尿频或夜尿症状。还根据基线症状严重程度、年龄和性别对亚组进行了分析。分类数据以各自人群中的百分比表示。连续数据表示为平均值或中位数，具体取决于变异是否被认为呈正态分布。
对失禁和尿频（约 50%）而言，症状缓解的可能性最大，但对尿急（约 20%）和夜尿（约 10%）而言则较小。症状的基线严重程度越高，治疗后摆脱该症状的可能性越低，但仍有相当大的机会摆脱失禁和尿频。年龄和性别对摆脱症状的可能性仅有轻微影响（如果有的话）。这些发现与少数随机对照试验的结果一致。
这些数据为膀胱过度活动症患者的治疗结果提供了合理的咨询证据基础。我们提出，合理的期望可以导致更高的长期依从性。
