Protocol for a Series of Systematic Reviews and Network Meta-analyses of Randomized Controlled Trials of Medications for Patients with Overactive Bladder Symptoms

We present the protocol for a series of systematic reviews and meta-analyses to assess the effectiveness and safety of first-line pharmacological treatments for overactive bladder with the aim of informing evidence-based clinical and health policy decisions. Multiple randomized controlled trials (RC...

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Published in:	European urology open science (Online) Vol. 69; pp. 89 - 99
Main Authors:	van der Worp, Henk, Puerto Nino, Angie K., Blanker, Marco H., Agarwal, Arnav, Aoki, Yoshitaka, Bauer, Scott R., Bhatnagar, Neera, Bolsunovskyi, Kostiantyn, te Brummelstroete, Gerhard H., Cárdenas, Jovita L., Cartwright, Rufus, Elterman, Dean, Eryuzlu, Leyla, Gaudel, Pramila, Gutschon, Rachel E., Griebling, Tomas L., Hallamies, Sanna K., Heikkilä, Katriina, Izhar, Zain, Kilpeläinen, Tuomas P., Khurshid, Saqib, Laakkonen, Sanna M., Lee, Yung, Lopes, Luciane C., Loohuis, Anne, Mendieta, Alexander, Mynttinen, Henri, Salehi-Pourmehr, Hanieh, Pryalukhin, Alexey, Przydacz, Mikolaj, Siddiqui, Fahad J., Tähtinen, Riikka, Vernooij, Robin W.M., Violette, Philippe D., Witte, Lambertus P.W., Yoshimura, Koji, Brignardello-Petersen, Romina, Guyatt, Gordon H., Tikkinen, Kari A.O.
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01-11-2024 Elsevier
Subjects:	Adrenergic β3 receptor agonists Clinical outcomes Multiple comparisons Muscarinic antagonists Network meta-analysis Overactive bladder Risk of bias Treatment Trial Protocol Urology Muscarinic antagonists Network meta-analysis Treatment Risk of bias Multiple comparisons Overactive bladder Adrenergic β3 receptor agonists Clinical outcomes Urology
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Summary:	We present the protocol for a series of systematic reviews and meta-analyses to assess the effectiveness and safety of first-line pharmacological treatments for overactive bladder with the aim of informing evidence-based clinical and health policy decisions. Multiple randomized controlled trials (RCTs) have examined first-line pharmacological agents such as anticholinergics and β3 agonists for the management of overactive bladder symptoms (OAB). Although earlier systematic reviews and (network) meta-analyses aimed to summarize the evidence, a substantial number of trials were not included, so a comprehensive and methodologically rigorous evaluation of the comparative effectiveness of all first-line pharmacological treatments is lacking. We aim to conduct a series of systematic reviews and network meta-analyses (NMAs) for a comprehensive assessment of the effectiveness and safety of first-line pharmacological treatments for OAB. Eligible studies will include RCTs comparing anticholinergics and β3 agonists to one another or to placebo in adults with OAB or detrusor overactivity. Pairs of reviewers with methodological training will independently evaluate candidate studies to determine eligibility and extract relevant data. We will incorporate patient-important outcomes, including urinary urgency episodes, urgency incontinence episodes, any type of incontinence episodes, urinary frequency, nocturia, and adverse events. We will conduct the NMAs using a frequentist framework and a graph theory model for each outcome. Analysis will follow rigorous methodologies, including handling of missing data and assessment of the risk of bias. We will conduct sensitivity and subgroup analyses and will apply the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to rate evidence certainty. Our approach aims to address the knowledge gap in the treatment of OAB by synthesizing evidence from RCTs worldwide. We will employ robust statistical methods, including frequentist NMA, to general clinically relevant and patient-important insights. Sensitivity and subgroup analyses will enhance the robustness and generalizability of our findings. Our reviews strive to inform evidence-based decisions in the management of OAB, to ultimate improve patient outcomes. Our study results may guide health policy decisions, such as reimbursement policies, and future studies in functional urology. The protocol for the review series is registered on PROSPERO as CRD42023266915.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors are joint first authors. OAB Investigators: Arnav Agarwal, Yoshitaka Aoki, Scott R. Bauer, Neera Bhatnagar, Kostiantyn Bolsunovskyi, Gerhard H. te Brummelstroete, Jovita L. Cárdenas, Rufus Cartwright, Dean Elterman, Leyla Eryuzlu, Pramila Gaudel, Rachel E. Gutschon, Tomas L. Griebling, Sanna K. Hallamies, Katriina Heikkilä, Zain Izhar, Tuomas P. Kilpeläinen, Saqib Khurshid, Sanna M. Laakkonen, Yung Lee, Luciane C. Lopes, Anne Loohuis, Alexander Mendieta, Henri Mynttinen, Hanieh Salehi-Pourmehr, Alexey Pryalukhin, Mikolaj Przydacz, Fahad J. Siddiqui, Riikka Tähtinen, Robin W.M. Vernooij, Philippe D. Violette, Lambertus P.W. Witte, Koji Yoshimura.
ISSN:	2666-1683 2666-1691 2666-1683
DOI:	10.1016/j.euros.2024.08.006