Behavioural noninferior to drug therapy for OAB symptoms in Parkinson’s disease

In the treatment of overactive bladder (OAB) in patients with Parkinson’s disease (PD), behavioural therapy compares favourably with drug therapy, according to the results of a noninferiority study.

The study included 77 veteran patients (mean age 71.3 years, 84 percent male) with PD (mean disease duration 6.6 years) who had an International Consultation on Incontinence Questionnaire OAB module (ICIQ-OAB) symptom score of at least 7 (range, 0–16; higher score indicates worse symptoms) and Montreal Cognitive Assessment (MOCA) score of at least 18 (range, 0–30).

The patients were randomly assigned to receive either behavioural therapy (n=36) or drug therapy (n=41) for 12 weeks. Carried out by a nurse practitioner, behavioural therapy involved pelvic floor muscle training and urge suppression strategies. For drug therapy, solifenacin was administered at 5 mg daily, with titration to 10 mg daily, if needed.

ICIQ-OAB scores at week 12 were evaluated as the primary outcome, with a noninferiority margin of 15 percent. Adverse events were assessed every 2 weeks through 8 weeks and again at 12 weeks.

Four patients in the drug group dropped out, leaving a total of 73 patients completing the study. Baseline characteristics were similar between the behavioural and drug groups, including MOCA score (mean, 24.8 vs 23.9) and ICIQ-OAB score (mean, 8.5 vs 9.1).

At week 12, ICIQ-OAB scores significantly decreased in both groups, establishing the noninferiority of behavioural therapy to drug therapy (p=0.02). The mean ICIQ-OAB score at week 12 was 5.5 and 5.8, respectively.

In terms of safety, dry mouth and falls occurred more frequently among patients in the drug group than among those in the behavioural group.

The present data provide evidence for the efficacy of behavioural therapy for OAB symptoms in PD.