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Onabotulinum toxin A improves neurogenic detrusor overactivity following spinal cord injury: a systematic review and meta-analysis

Spinal Cord (2024)Cite this article

Subjects

Abstract

Study design

Systematic review and meta-analysis.

Objectives

The current study aimed to assess the efficacy and safety of Onabotulinum toxin A (OBTX-A) treatment for neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients.

Setting

Iran.

Methods

All relevant articles of clinical trials and cohort studies indexed in PubMed/MEDLINE, Embase, Scopus, and Web of Science databases up to September 6, 2022, that addressed OBTX-A treatment for NDO following SCI were included. The quality of eligible studies was evaluated using Cochrane criteria. Also, the weighted mean difference (WMD) was measured with a random-effect model.

Results

Regarding the overall efficacy after OBTX-A treatment in the short term, volume per void (VV) (WMD = 118.8, 95% CI: 90.9–146.7, p < 0.01), incontinence-quality of life (IQoL) (WMD = 24.3, 95% CI: 15.8–32.8, p < 0.01), and maximum cystometric capacity (MCC) (WMD = 144.5, 95% CI: 132.3 to 156.7, p < 0.01) significantly increased, while maximum detrusor pressure during storage (MDP) (WMD = –30.5, 95% CI: –35.9 to –25.1, p < 0.01) showed a significant decrease. Furthermore, compared to the placebo group at the 200-unit dose, there was a significant increase in MCC (WMD = 113.5, 95% CI: 84.7 to 142.3, p < 0.01) and a significant decrease in MDP (WMD = −27.2, 95% CI: −39.2 to −15.1, p < 0.01). Urinary tract infection (UTI), hematuria, and autonomic dysreflexia were the most common side effects, occurring at rates of 29.6%, 14.8%, and 13.4%, respectively.

Conclusion

Our findings highlighted the effectiveness and safety of OBTX-A as a promising treatment of NDO following SCI.

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Fig. 1
Fig. 2
Fig. 3: Forest plot of the meta-analysis of short- and long-term efficiency of Onabotulinum toxin A on maximum detrusor pressure (MDP) during storage.
Fig. 4: Forest plot of the meta-analysis of short- and long-term efficiency of Onabotulinum toxin A on maximum cytometric capacity (MCC).

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Data availability

All the required information is in the manuscript and supplementary file.

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Authors and Affiliations

  1. Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Saeed Vaheb, Yousef Mokary, Hamed Ghoshouni, Omid Mirmosayyeb, Elham Moases Ghaffary & Vahid Shaygannejad

  2. Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Omid Mirmosayyeb & Vahid Shaygannejad

  3. Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran

    Mohammad Yazdan Panah

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Contributions

OM, VS and MYP were responsible for designing the review protocol. SV and MYP conducted the search. SV and EMG screened potentially eligible studies. SV and HG extracted data from included studies. HG and MYP analyzed data and interpreted results. YM, EMG, MYP wrote the entire manuscript and OM, VS, MYP reviewed and edited manuscript.

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Vaheb, S., Mokary, Y., Ghoshouni, H. et al. Onabotulinum toxin A improves neurogenic detrusor overactivity following spinal cord injury: a systematic review and meta-analysis. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-00992-9

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