Comprehensive overview of the available pharmacotherapy for the treatment of non-neurogenic overactive bladder in children

ABSTRACT

Introduction

Overactive bladder (OAB) is a chronic condition highly prevalent in children and causing bothersome symptoms. It is often associated with deterioration of quality of life and can be devastating for patients and their families. Prompt initiation of conservative measures should be the backbone of treatment. When conservative management fails, pharmacological options must be considered.

Areas covered

Although antimuscarinics are considered the mainstay of pharmacological treatment for OAB, only two agents are currently approved for the pediatric population. Oxybutynin and propiverine are discussed in this review, as well as other non-approved antimuscarinic agents and β3-agonists with related literature to substantiate their use in children. Dual therapy along with medication adherence and persistence is also discussed.

Expert opinion

The treatment of OAB in children is demanding and one must rely on a structured, stepwise approach to achieve success. Discussing conservative measures and prescribing medication is not enough. Clinicians should actively involve children and their families in the treatment, set realistic expectations, and closely monitor side effects and medication adherence to ensure maximal efficacy.

KEYWORDS:

• Antimuscarinics
• children
• fesoterodine
• mirabegron
• overactive bladder
• oxybutynin
• propiverine
• solifenacin
• tolterodine
• trospium

Article highlights

• Conservative measures, particularly the treatment of constipation, are quintessential in the management of OAB in children.

• Every child with OAB should be treated in an individualized, structured approach with both patient and family well educated about the condition and its stepwise management.

• Although oxybutynin and propiverine are the only agents approved in children with non-neurogenic OAB, newer antimuscarinics and β3-agonists have been studied and used in the pediatric population at a suitable level to include them in a standard pediatric OAB management algorithm.

• When monotherapy is unsatisfactory or if maximal medication dosage cannot be achieved because of bothersome side effects, pharmacological treatment could be optimized either by combining 2 antimuscarinic medications or by using a dual medication strategy (antimuscarinic agent and β3-agonist simultaneously).

• Medication adherence and persistence have been minimally studied in children with OAB but should be given more emphasis to ultimately increase treatment efficacy.

• Invasive treatment options, such as intradetrusor botulinum toxin injections and neurostimulation, should be reserved for intractable OAB cases.

Declaration of interest

S Bolduc was co-PI on an international study on solifenacin in children between 2010-13 with Astellas and also received a grant from Pfizer Canada to run a trial comparing oxybutynin to fesoterodine between 2014-2017. Finally, S Bolduc has received the Ferring Innovation grant for a fundamental research project on bladder cancer in 2015. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

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

Additional information

Funding

The authors are supported by the Fondation du CHU de Québec