Objective: Assess the comparative effectiveness of behavioral or solifenacin drug therapy over 12 weeks for overactive bladder (OAB) symptoms according to the International Consultation on Incontinence OAB (ICIQ-OAB) symptom score in persons with Parkinson disease (PD).

Background: OAB symptoms in PD are burdensome and the side effects of anticholinergic bladder relaxant drugs could worsen cognitive function. Pelvic floor muscle exercise-based behavioral therapy shows promise to treat OAB symptoms in PD and avoids drug side effects.

Method: Randomized, non-inferiority trial conducted from 2018-2023 in 4 United States Veterans Affairs Healthcare Systems including persons with PD and ICIQ-OAB symptom score of ≥ 7 (0-16; higher = worse OAB symptoms, minimally important difference ≥ 2 points) and Montreal Cognitive Assessment of ≥ 18 (0-30; high=better cognition, < 18 consistent with moderate impairment) were eligible. Behavioral therapy was implemented by a continence nurse practitioner over two weeks. Solifenacin therapy started at 5 mg daily. Adverse drug events were assessed every 2 weeks after randomization for 8 weeks and again at 12 weeks. Comparative effectiveness was based on evaluation of the 12-week ICIQ-OAB scores across groups within a 15% non-inferiority margin (p < 0.05 indicates non-inferiority).

Results: 77 persons with PD were randomized (71.3 ± 8.9, range 46-87 years, 84% male, 6.6 ± 5.8 years with PD) with 36 to behavioral and 41 to drug therapy. 73 participants completed the study (4 dropouts in drug). Baseline characteristics were balanced across groups including age, sex, duration of PD, PD motor symptoms, MoCA (23.9 ± 3.1 (Drug), 24.8 ± 3.3 (Behavioral)), and baseline ICIQ-OAB score (9.1 ± 1.7 (Drug), 8.5 ± 1.4 (Behavioral)). At 12 weeks post-randomization, the final ICIQ-OAB scores across groups were within the a priori margin of 15% to determine non-inferiority (5.8 ± 2.4 (Drug), 5.5 ± 2.0 (Behavioral), p=0.02). Among those who completed drug treatment, dry mouth was reported more frequently compared to the behavioral group.

Conclusion: Behavioral therapy is a viable initial treatment of OAB symptoms in PD, including among persons with cognitive impairment. While study-emergent adverse drug events were mild and the dropout rate was low, overall, only participants assigned to drug therapy discontinued treatment.

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/comparative-effectiveness-of-behavioral-or-drug-therapy-for-overactive-bladder-symptoms-in-parkinson-disease/