Combination therapy studies of third-line treatments were rare and centered on medication with PTNS .
Combination therapy , with certain first , second , and third-line OAB therapies , appears to be efficacious .
AIMS Overactive bladder ( OAB ) affects over 17 % of the population and significantly effect the health-related quality of life .
The treatments for OAB include first line ( lifestyle modification , pelvic floor muscle training ) , second line ( anticholinergic or beta-3 agonist medications ) , and third line therapies ( intradetrusor botulinum toxin injection , sacral neurostimulation [ SNM ] , or percutaneous tibial nerve stimulation [ PTNS ] ) .
For those with urinary incontinence secondary to OAB , complete continence is the goal of therapy , though cure rates are only 5 % to 40 % .
The use of combination therapies can be employed in refractory OAB , however , the efficacy of pooled modalities is relatively unknown .
Our objective was to determine the volume of data supporting combination therapy in treating OAB .
Low‐dose Desmopressin and Tolterodine Combination Therapy for Treating Nocturia in Women with Overactive Bladder: A Double‐blind, Randomized, Controlled Study
OBJECTIVE Evaluation of safety and efficacy of desmopressin/tolterodine combination therapy in women . METHODS This double-blind , r and omized , proof-of-concept study enrolled 106 patients ( ≥18 years ) , with overactive bladder ( OAB ) and nocturia , with ≥2 nocturnal voids , receiving a 3-month once-daily combination ( desmopressin 25 µg , orally-disintegrating tablets [ODT]/tolterodine 4 mg [ Detrol ® LA ] ; n = 49 ) or monotherapy ( tolterodine 4 mg/placebo ODT ; n = 57 ) . Primary endpoint was change from baseline in mean number of nocturnal voids . Secondary endpoints were change from baseline in nocturnal voided volume , time to first nocturnal void , and quality -of-life . Post-hoc exploratory analysis were performed for patients with and without baseline nocturnal polyuria ( NP , n = 47 each ) . RESULTS Overall population showed a non-significant reduction in mean number of nocturnal voids with combination versus monotherapy ( full analysis set : adjusted treatment contrast [ TC ] , -0.34 ; P = 0.112 ) . Change in mean nocturnal void volume ( TC , -64.16 mL ; P = 0.103 ) , mean time to first nocturnal void ( TC , 18.00 min ; P = 0.385 ) and Nocturia Impact ( NI ) Diary © scores were comparable . In post-hoc analysis , NP patients showed a benefit with combination versus monotherapy for nocturnal void volume ( P = 0.034 ) and time to first nocturnal void ( P = 0.045 ) , and a non-significant improvement in NI Diary © scores . Safety profile was comparable between treatments . A single transient event of asymptomatic clinical ly significant hyponatremia in combination group resolved subsequently . CONCLUSION Low-dose desmopressin could be safely combined with tolterodine for treating nocturia in women with OAB , with a significant benefit in women with NP . Further , prospect i ve validation studies of combination therapy are warranted in mixed NP/OAB population , based on this favorable proof-of-concept finding
Combination therapy studies of third-line treatments were rare and centered on medication with PTNS .
Combination therapy , with certain first , second , and third-line OAB therapies , appears to be efficacious .
AIMS Overactive bladder ( OAB ) affects over 17 % of the population and significantly effect the health-related quality of life .
The treatments for OAB include first line ( lifestyle modification , pelvic floor muscle training ) , second line ( anticholinergic or beta-3 agonist medications ) , and third line therapies ( intradetrusor botulinum toxin injection , sacral neurostimulation [ SNM ] , or percutaneous tibial nerve stimulation [ PTNS ] ) .
For those with urinary incontinence secondary to OAB , complete continence is the goal of therapy , though cure rates are only 5 % to 40 % .
The use of combination therapies can be employed in refractory OAB , however , the efficacy of pooled modalities is relatively unknown .
Our objective was to determine the volume of data supporting combination therapy in treating OAB .