Study finds high rates of discontinuation for overactive bladder treatment

"I think a great next step would be some patient-centered research, maybe in a qualitative fashion," said Dr. Woodburn.

In the following interview, Katherine L. Woodburn, MD, shares notable findings from the recent study, “OnabotulinumtoxinA discontinuation in patients with prior nerve stimulation,” which looked at patients that discontinued onabotulinumtoxinA (Botox) treatment for overactive bladder.¹ Woodburn is an assistant professor of urogynecology at Atrium Health Wake Forest Baptist in High Point and Winston-Salem, North Carolina.

Could you describe the background for this study?

This is a retrospective study that we did at the single institution, which is in an urban setting. This was all looking at community-dwelling women who had overactive bladder symptoms. We wanted to know why or what made these women stop Botox treatment, and were there any factors including prior exposure to nerve stimulation that might have an impact on stopping Botox treatment.

What were some of the notable findings? Were any of those surprising to you and your coauthors?

We noted in our overall population, which was about 214 women, there was a 40% discontinuation rate for Botox treatments in the office. This wasn't that surprising. It matches up with a lot of what the other literature suggest. We did find that patients who had recurrent treatment associated urinary tract infections (UTIs) had a higher chance of stopping Botox treatment.

What really surprised us was that 25% of our Botox cohort had previously undergone nerve stimulation, whether that's sacral neuromodulation or peripheral tibial nerve stimulation, and those patients were less likely to stop Botox.

Is any further research on this topic planned? If so, what might that focus on?

I don't currently have any research going on in this area, but we are looking about how Botox works in a more elderly patient population as well as if factors play into their discontinuation rates of Botox.

I think based on the findings of our study, it would be interesting to look at why patients are stopping Botox. A lot of the patients in our study and other studies previously published are lost to follow-up, and we need more information. Did they stop because it wasn't working? Did they stop for other reasons? I think a great next step would be some patient-centered research, maybe in a qualitative fashion.

What is the take-home message for practicing urologists based on this study?

I think unfortunately, our study corroborates that there are high Botox discontinuation rates for patients overall. That's probably the biggest take-home, as well as the fact that patients who have recurrent treatment associated infections are more likely to stop. So maybe being a little bit more aggressive in how we treat or prevent those treatment associated UTIs could be helpful for those patients. Overall, we need more information about why women choose to stop Botox treatment and if there are things that we could be helping in that regard.

Is there anything else that you'd like to add?

I think the [one] thing that's nice to note about our study is that we did have a very diverse population. 50% of our patient cohort was Black, which is something that's not seen in a lot of the previously published Botox literature. Although we wouldn't anticipate any differences because of that, it's nice that we were able to include a wide variety of patients.

Reference

1. Woodburn K, Hoang E, Quan K, Pennycuff J, Richter LA. OnabotulinumtoxinA discontinuation in patients with prior nerve stimulation. Neurourol Urodyn. Published online December 26, 2022. Accessed January 26, 2023. doi:10.1002/nau.25121.