Behavioural therapy as good as medication for OAB symptoms in Parkinson’s disease

In the treatment of overactive bladder (OAB) in patients with Parkinson’s disease (PD), exercise-based behavioural therapy helps reduce symptoms and bother scores and improve quality of life, similar to what is achieved with drug therapy, as shown in a study.

After 12 weeks, mean ICIQ-OAB* symptom scores improved significantly in both groups, dropping from 8.5 points at baseline to 5.5 points with behavioural therapy and from 9.1 to 5.8 points with solifenacin. [JAMA Neurol 2025;82:925-931]

Accordingly, the ICIQ-OAB bother scores declined significantly, from 27.8 to 17.2 points in the behavioural therapy group and from 28.7 to 17 points in the solifenacin group. ICIQ-OAB quality of life scores also decreased in both groups, indicating an improvement.

Behavioural therapy showed noninferiority to drug therapy with solifenacin for all three outcomes. The  investigators highlighted that the intervention yielded positive outcomes even in patients with evidence of cognitive impairment, with exploratory analyses showing no statistical difference in the 12-week OAB symptom score based on the level of cognitive function as measured by the Montreal Cognitive Assessment.

Falls risk

Adverse events (AEs) occurred more frequently with solifenacin than behavioural therapy, including dry mouth (60 percent vs 25 percent; p=0.002) and pain or burning with urination (12.5 percent vs 0; p=0.03).

Of note, serious AEs such as falls occurred in six patients who received solifenacin and in none of those who received behavioural therapy. One episode of fall resulted in a hip fracture, and the patient remained in the study after rehabilitation.

“The finding of increased falls in the solifenacin therapy group reinforces the need to carefully consider the risk-benefit ratio of medications for urinary symptoms,” especially since patients with PD are already at increased risk of falls, the investigators noted.

“Given the potential AEs and burden of drug therapy, these results suggest behavioural therapy may be a suitable initial treatment approach, even among persons with PD and mild cognitive dysfunction,” they added.

Patient retention

The study was designed to keep as many patients as possible involved for the full duration. This was done by allowing a dose increase for insufficiently treated symptoms, as well as an opportunity for patients to continue in the study even if they decided to stop taking solifenacin.

At 6 weeks, nine patients (22 percent) on solifenacin opted for a dose increase, from 5 to 10 mg once daily, based on inadequate symptom control. All eight patients (19.5 percent) who requested to discontinue their medication because of TEAEs remained in the study for outcome assessments.

Four patients (9.7 percent) in the drug therapy group dropped out of the study, including one due to treatment-emergent AEs (TEAEs). There were no dropouts in the behavioural therapy group.

Study details

The study included 77 patients with PD (mean age 71.3 years, 84 percent male, mean PD duration 6.6 years) with an ICIQ-OAB symptom score of at least 7 (range 0–16, with higher scores indicating worse symptoms) and MOCA score of at least 18 (range 0–30).

The patients were randomly assigned to receive behavioural therapy (n=36) or drug therapy with solifenacin (n=41). Baseline characteristics were similar between the treatment groups.

Patients in the behavioural therapy group underwent a comprehensive training program administered individually by a trained nurse practitioner interventionist. The program involved teaching pelvic floor muscle exercises and urge suppression strategies to overcome the urge to void. Pelvic floor muscle exercises included sets of 15 exercises, three times per day, requiring a total of 7–10 mins daily to complete.

The drug therapy group received solifenacin at a dose of 5 mg once daily, with dose escalation to 10 mg permitted in case of inadequate symptom control. Solifenacin was selected during the design phase of the study based on the best available evidence. [Parkinsonism Relat Disord 2015;21:514-520]