Long-term efficacy of dextranomer in stabilized hyaluronic acid (NASHA/Dx) for treatment of faecal incontinence

• Published in: Colorectal disease Vol. 15; no. 5; pp. 569 - 574
• Main Authors: La Torre, F., de la Portilla, F.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.05.2013
• Subjects: Aged; Bulking agent; dextranomer; Dextrans - adverse effects; Dextrans - therapeutic use; faecal incontinence; Fecal Incontinence - drug therapy; Female; Fever - chemically induced; Follow-Up Studies; Gastrointestinal Agents - adverse effects; Gastrointestinal Agents - therapeutic use; Humans; Hyaluronic Acid - adverse effects; Hyaluronic Acid - therapeutic use; Male; Middle Aged; Pain - chemically induced; Quality of Life; Rectum; Severity of Illness Index; Solesta; Time Factors
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.12155

Aim Randomized, controlled trials have demonstrated the efficacy and safety of injectable bulking agents for the treatment of faecal incontinence (FI), although the long‐term outcome has not been assessed. NASHA/Dx gel, a biocompatible, nonallergenic bulking agent consisting of nonanimal stabilized hyaluronic acid and dextranomer microspheres, has demonstrated efficacy and safety for up to 12 months after treatment. The objective of this study was to evaluate the long‐term efficacy and safety of NASHA/Dx, assessed 24 months after treatment. Method This study was a 24‐month follow‐up assessment of patients treated with NASHA/Dx under open‐label conditions. Data on FI episodes and quality of life measures were collected from diaries over the 28‐day period immediately preceding the 24‐month assessment. Adverse events were collected. Results Eighty‐three of 115 patients completed the 24‐month follow‐up assessment. At 24 months, 62.7% of patients were considered responders and experienced a ≥ 50% reduction in the total number of FI episodes. The median number of FI episodes declined by 68.8% (P < 0.001). Episodes of both solid and liquid stool incontinence decreased. The mean number of incontinence‐free days increased from 14.6 at baseline to 21.7 at 24 months (P < 0.001). Incontinence scores and FI quality of life scores also showed significant improvements. The most common adverse events (AEs) were proctalgia (13.3%) and pyrexia (9.6%). The majority of AEs were mild to moderate, self‐limited and resolved within 1 month of the injection. Conclusion NASHA/Dx is safe, effective and durable over a 24‐month period with a majority of patients experiencing significant improvement in multiple symptoms associated with FI.