Oral anticholinergic therapy and injectable onabotulinumtoxinA are similarly efficacious in treating urgency urinary incontinence, according to a New England Journal of Medicine study.

Some 250 women without neurological disease who had moderate-to-severe urgency incontinence were randomized either to a single injection of onabotulinumtoxinA into the detrusor muscle plus a daily oral placebo for 6 months, or to a single injection of saline plus dose-escalation with a daily oral anticholinergic for 6 months.

The primary outcome — the mean number of urgency incontinence episodes — was similarly reduced in the two groups (roughly 3 fewer episodes/day). OnabotulinumtoxinA recipients were twice as likely as anticholinergic recipients to report complete resolution of urgency incontinence (27% vs. 13%). Dry mouth was significantly more common with anticholinergic therapy, whereas urinary tract infections and incomplete bladder emptying requiring catheterization were significantly more common with onabotulinumtoxinA.

The researchers conclude that “the choice between these therapies should take into account the differing regimens and routes of administration and the side-effect profiles.”

Source: NEJM