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Comparison study of OnabotulinumtoxinA 300U and 200U in patients with detrusor overactivity

Comparison study of OnabotulinumtoxinA 300U and 200U in patients with detrusor overactivity. YUAG 4 th November 2011. Altaf Mangera , Manar Malki, Sheila Reid, Richard Inman, Chris Chapple. Introduction.

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Comparison study of OnabotulinumtoxinA 300U and 200U in patients with detrusor overactivity

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  1. Comparison study of OnabotulinumtoxinA300U and 200U in patients with detrusor overactivity YUAG 4th November 2011 Altaf Mangera, Manar Malki, Sheila Reid, Richard Inman, Chris Chapple

  2. Introduction Botulinum toxin (BTX) causes a neuromuscular blockade of vesicular Ach release at the neuromuscular junction There are seven serotypes BTX-A to BTX-G BTX-A was the first licensed serotype under the trade name Botox Other formulations of BTX-A also exist including Dysport, Xeomin, Prosigne, Neuronox and Purtox FDA have approved new terminology and “Botox” is called onabotulinumtoxinA No BTX preparation is currently licensed for use in any urological applications

  3. Background • Schurch first described the use of BTX-A for NDO in 2000 • This was later expanded to included patients with IDO • A recent systematic review revealed that there were: -28 studies reporting the outcomes of 1068 patients with NDO -26 studies reporting the outcomes of 1150 patients with IDO • In all the studies 50 to 300u were used but never in the same patients

  4. Methods and Aim • In our unit all patients received 300u onabotulinumtoxinA for both NDO and IDO until June 2007- an audit was completed at the time • Since July 2007 we began to inject 200u in all patients • Patients who were audited in 2007 were re-audited in 2011 • Aim: was to assess the patient reported efficacy and duration of effect of 300u vs. 200u onabotulinumtoxinA

  5. Patients June 2007: Audit of 300u (n=79) SPC (n=4) Stopped BTX due to inefficacy (n=11) Clam cystoplasty (n=4) Neuromodulation (n=1) TOT (n=1) Ileal conduit (n=2) Symptom cure (n=1) TURP (n=1) Discharged back to DGH (n=5) Lost to follow up (n=4) RIP (n=1) Audit of 200u (n=44) NDO (n=16) IDO (n=28)

  6. Results • 44 patients (36 F & 8 M), received 300u followed by 200u • Of these; 37 (84%) reported continued improvement • 4 (9%) reported no benefit and 3 (7%) had worsening of their symptoms • 4 (9%) all with NDO went back to receiving 300u with good effect • 2 (5%) had another 200u after 5mo and did report further benefit • Longevity of efficacy was the same in both 200 and 300u groups (5mo) • 3 (7%) patients all with IDO had to commence CISC for de novo voiding difficulty after 200u • No difference in UTI/other complication rates

  7. Conclusions • Patients who have received 300u may be switched to 200u (90% patients satisfied) • There was no reduction in longevity of effect • NDO patients may require 300u • Switch to lower dose did not lead to a reduction of ISC rate but an increase!

  8. Thank you Questions?

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