Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis
Objective: To compare these managements focusing on the efficacy and safety to treat overactive bladder (OAB) in children through network meta-analysis (NMA). Methods: We searched PubMed, Embase, the Cochrane Library Central Register of Controlled Trials (CENTRAL) and the reference lists up to May 1st, 2017. Data from eligible randomized controlled trails (RCT) studies including three different treatment options were extracted. The primary outcome was maximal voiding volume (MVV). We performed pairwise meta-analyses by random effects model and NMA by Bayesian model. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework to assess the quality of evidence contributing to each network estimate. Results: Six RCTs (462 patients) comparing three different interventions fulfilled the inclusion criteria. A low risk of bias was shown for the majority of the study items. The results of NMA showed that compared with antimuscarinic drugs, Parasacral transcutaneous electrical nerve stimulation was associated with significant improvement in the MVV (mean difference [MD] = 58.50, 95% confidential interval [CI]: 45.95-69.52), followed by urotherapy group (MD = 21.03, 95% CI: 11.85-29.97). When it comes to the constipation, antimuscarinic drugs exerted significant benefit than PTENS (odds ratio [OR]: 0.22, 95% CI: 0.01-0.46). No significant difference was found between other treatments. Conclusion: Compared with antimuscarinic drugs, PTENS was associated with significant better efficacy considering MVV, but more constipation events in de novo OAB children. Antimuscarinic drugs showed remarkably better efficacy considering MVV and comparable safety profile compared with urotherapy. Clinicians should take all known safety and compliance of patients into account when choosing an optimal strategy.
. [J]. Asian Journal of Urology, 2019, 6(4): 330-338.
Shi Qiu,Siwei Bi,Tianhai Lin,Zhuheng Wu,Qi’an Jiang,Jiwen Geng,Liangren Liu,Yige Bao,Xiang Tu,Mingjing He,Lu Yang,Qiang Wei. Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis. Asian Journal of Urology, 2019, 6(4): 330-338.
Antimuscainic (oxybutynin) and sham electric stimulation (15)
10 Hz
20
6
Three times a week
Marschall-Kehrel et al. [21]
2009
Germany
Antimuscarinic (propiverine) (87)
Placebo (84)
NA
NA
8
Twice daily
Newgreen et al. [22]
2016
Netherlands
Antimuscarinic (Solifenacin) (73)
Placebo (73)
NA
NA
12
Once daily
Comparison
No. of participants
No. of trials
Pairwise meta-analysis mean difference/odd ratios (95% CI)
p-Value
Heterogeneity, I2
Network meta-analysis, mean difference/odds ratios (95% CrI)
Quality of evidence
Downgraded reason
Maximal voiding volume
PTENS vs. urotherapy
196
2
NA
NA
NA
37.46 (28.27, 45.24)
⊕⊕○○ low
Inconsistency and imprecision
Antimuscarinic vs. urotherapy
307
2
20.49 (6.80, 34.17)
0.1
64%
21.03 (11.85, 29.97)
⊕⊕⊕○ moderate
heterogeneity
PTENS vs. antimuscarinic
239
0
NA
NA
NA
58.50 (45.95, 69.52)
⊕⊕○○ low
Heterogeneity and imprecision
Voiding frequency
PTENS vs. urotherapy
196
2
NA
NA
NA
0.425 (-2.21, 2.76)
⊕⊕○○ low
Inconsistency and imprecision
Antimuscarinic vs. urotherapy
307
2
-0.80 (-1.29, -0.31)
1
0
1.09 (-1.18, 3.40)
⊕⊕○○ low
Inconsistency and imprecision
PTENS vs. antimuscarinic
239
0
NA
NA
NA
0.67 (-2.213, 3.71)
⊕⊕○○ low
Heterogeneity and imprecision
Incontinence episodes
PTENS vs.urotherapy
219
1
NA
NA
NA
0.13 (-4.88, 5.44)
⊕⊕○○ low
Inconsistency and imprecision
Antimuscarinic vs. urotherapy
349
2
-0.30 (-0.54, -0.05)
0.81
0
0.23 (-3.41, 3.74)
⊕⊕○○ low
Inconsistency and imprecision
PTENS vs. antimuscarinic
190
0
NA
NA
NA
0.09 (-6.79, 6.59)
⊕⊕○○ low
Heterogeneity and imprecision
Constipation
PTENS vs. urotherapy
29
1
0.21 (0.04, 1.12)
0.51
0
0.38 (0.01, 6.85)
⊕⊕⊕○ moderate
Heterogeneity
Antimuscarinic vs. urotherapy
23
0
NA
NA
NA
0.15 (0.25, 3.82)
⊕⊕○○ low
Heterogeneity and imprecision
PTENS vs. antimuscarinic
36
1
NA
NA
NA
0.22 (0.01, 0.46)
⊕⊕○○ low
Inconsistency and imprecision
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