Long‐term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity

• Published in: Neurourology and urodynamics Vol. 37; no. 2; pp. 799 - 806
• Main Authors: Joussain, Charles, Popoff, Mélanie, Phé, Véronique, Even, Alexia, Bosset, Pierre‐Olivier, Pottier, Sandra, Falcou, Laetitia, Levy, Jonathan, Vaugier, Isabelle, Chartier Kastler, Emmanuel, Schurch, Brigitte, Denys, Pierre
• Format: Journal Article
• Language: English
• Published: United States 01-02-2018
• Subjects: Administration, Intravesical; Adult; botulinum toxin; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - therapeutic use; Female; Humans; Injections; Intermittent Urethral Catheterization; Kaplan-Meier Estimate; long‐term care; Male; Middle Aged; Muscle, Smooth; neurogenic; Retrospective Studies; Risk Factors; Survival Analysis; Treatment Failure; type A; urinary bladder; Urinary Bladder, Neurogenic - drug therapy; Urinary Bladder, Overactive - drug therapy; Urodynamics; botulinum toxin; risk factors; type A; intermittent urethral catheterization; urinary bladder; long-term care; neurogenic
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.23352

Aims
Aims of this study were to assess the long‐term outcomes of Intradetrusor injection of OnabotulinumtoxinA (Botox® injection) associated with clean intermittent‐catheterization (CIC) for the treatment of neurogenic detrusor overactivity (NDO) and to identify risk factors for failure.
Methods
Neurological patients with NDO using CIC who had received Botox® injections between January 2001 and September 2013 were included. Clinical, urodynamic and radiological data were recorded. Primary endpoint was failure and withdrawal rates after 3, 5, and 7 years of management. Survival curves of withdrawals and failures of treatment were calculated with a 95‐confidence interval using the Kaplan‐Meier method. Risk factors for failure were determined with univariate analysis and multivariate analysis using Cox model.
Results
Overall, 292 patients, mean age of 40 ± 13, 6 years, were included. Overall, 219 patients (80.6%; IC95% [76.3‐85.4%]) were still treated with Botox® injections after 3 years, 128 (71.1%; IC95% [65.7%, 76.9%]) after 5 years, and 58 (60.8%, IC95% [54.0%, 68.4%]) after 7 years. Failure rate was 12.6% (IC95% [8.6‐16.5%]) after 3 years, 22.2% (IC95% [16.6‐27.3%]) after 5 years, and 28.9% (IC95% [21.9%; 35.3%]) after 7 years of follow‐up. Withdrawal rate after 7 years of follow‐up was 11.3% (n = 33/292). Severe NDO at baseline appears to be a significant risk factor for failure.
Conclusion
This study confirms long‐term efficacy and tolerance of Botox® injection in patients with NDO using CIC. Long‐term failure and withdrawal rates remain low but significant, and need to be managed.