Managing urinary incontinence in women - a review of new and emerging pharmacotherapy

ABSTRACT

Introduction

The pharmacological treatment of urinary incontinence and overactive bladder (OAB) has been, for a longer time, based on antimuscarinic agents. In recent years, two other pharmacological principles have been introduced for the treatment of OAB and urgency urinary incontinence: the β3-adrenergic agent mirabegron and botulinum neurotoxin. Meanwhile, there is lack of effective drugs for the treatment of stress incontinence.

Areas covered

This literature review presents synthetic compounds aimed to treat female urinary incontinence that are in phase II-III clinical development.

Expert opinion

Antimuscarinic agents will continue to represent the current gold standard for the first-line pharmacological management of OAB and urgency urinary incontinence. The class of β3-agonists will certainly expand with the discovery and clinical development of novel agents. Combination therapy of antimuscarinic agents and β3-agonists could offer an alternative treatment in these patients, including those with symptoms refractory to first-line monotherapy. A huge number of preclinical studies are underway in this field exploring the therapeutic potential of many novel compounds while some have advanced to clinical phases of development.

KEYWORDS:

• Pharmacological therapy
• overactive bladder
• urinary incontinence
• female urinary incontinence

Article highlights

• Antimuscarinic agents are still the object of intensive investigation due to their effectiveness

• Newer antimuscarinic drugs have produced promising results in several clinical trials

• Novel β3-agonists have displayed good results in treating overactive bladder symptoms in clinical studies

• Combination therapies, such as β3-agonists + antimuscarinics, appeared effective and well tolerated in refractory overactive bladder patients

• The future of overactive bladder treatment include PDE5-inhibitors, liposomes, and purinergic receptors blockers

• Duloxetine, reboxetine, and midodrine seem to have a good efficacy in treating stress urinary incontinence

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.