Intravesical injections of botulinum neurotoxin A to treat overactive bladder and/or detrusor overactivity related to multiple sclerosis: 5-Year continuation rate and specific risk factors for discontinuation-A study from the neuro-urology committee of the French Association of Urology

• Published in: Multiple sclerosis Vol. 29; no. 8; p. 1024
• Main Authors: Delaval, Stéphanie, Dequirez, Pierre-Luc, Hentzen, Claire, Baron, Maximilien, Mille, Eva, Tariel, François, Peyronnet, Benoit, Perrouin-Verbe, Marie-Aimée, Pierache, Adeline, Chartier-Kastler, Emmanuel, Capon, Grégoire, Cornu, Jean-Nicolas, Castel-Lacanal, Evelyne, Gamé, Xavier, Karsenty, Gilles, Ruffion, Alain, Denys, Pierre, Even, Alexia, Joussain, Charles, Amarenco, Gérard, Phé, Véronique, Biardeau, Xavier
• Format: Journal Article
• Language: English
• Published: England 01.07.2023
• Subjects: Administration, Intravesical; Botulinum Toxins, Type A - adverse effects; Humans; Multiple Sclerosis - chemically induced; Multiple Sclerosis - complications; Neuromuscular Agents - adverse effects; Retrospective Studies; Treatment Outcome; Urinary Bladder, Neurogenic - drug therapy; Urinary Bladder, Neurogenic - etiology; Urinary Bladder, Overactive - complications; Urinary Bladder, Overactive - etiology; Urology; Symptomatic treatment; neurogenic bladder; self-catheterization; detrusor overactivity; urology
• ISSN: 1477-0970
• DOI: 10.1177/13524585231174580

While intravesical injections of botulinum neurotoxin A (BoNT-A) are currently recommended for patients experiencing refractory neurogenic overactive bladder and/or detrusor overactivity (OAB/DO), it is unclear how much this therapy is effective and sustainable in the long-term in patients with multiple sclerosis (MS). To assess the mid-term continuation rate of BoNT-A injections to treat neurogenic OAB/DO in MS patients and to investigate MS-specific risk factors for discontinuation. This retrospective study involved 11 French university hospital centers. All MS patients who received BoNT-A to treat neurogenic OAB/DO between 2008 and 2013 and were subsequently followed up for at least 5 years were eligible. Of the 196 MS patients included, 159 (81.1%) were still under BoNT-A 5 years after the first injection. The combination of the Expanded Disability Status Scale (EDSS < 6 or ⩾ 6) and of the MS type (relapsing-remitting vs progressive) predicted the risk of discontinuation. This risk was 5.5% for patients with no risk factor, whereas patients presenting with one or two risk factors were 3.3 and 5.7 times more likely to discontinue, respectively. BoNT-A is a satisfying mid-term neurogenic OAB/DO therapy for most MS patients. Combining EDSS and MS type could help predict BoNT-A discontinuation.