Articles

Collaborative Review – Neuro-urology

Contemporary Management of Lower Urinary Tract Disease With Botulinum Toxin A: A Systematic Review of Botox (OnabotulinumtoxinA) and Dysport (AbobotulinumtoxinA)

By: Altaf Mangeraa lowast , Karl-Erik Anderssonb, Apostolos Apostolidisc, Chris Chapplea, Prokar Dasguptad, Antonella Giannantonie, Stavros Gravasf and Stephan Madersbacherg

European Urology, Volume 60 Issue 1, October 2011, Pages 784-795

Published online: 01 October 2011

Keywords: bobotulinumtoxinA, Bladder outflow obstruction, Botox, Botulinum toxin, Detrusor sphincter dyssynergia, Dysport, Idiopathic detrusor overactivity, Neurogenic detrusor overactivity, OnabotulinumtoxinA, Painful bladder syndrome

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Abstract

Context

The use of botulinum toxin A (BoNTA) in the treatment of lower urinary tract dysfunction has expanded in recent years and the off-licence usage list includes neurogenic detrusor overactivity (NDO), idiopathic detrusor overactivity (IDO), painful bladder syndrome (PBS), and lower urinary tract symptoms resulting from bladder outflow obstruction (BOO) or detrusor sphincter dyssynergia (DSD). There are two commonly used preparations of BoNTA: Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA).

Objective

To compare the reported outcomes of onabotulinumtoxinA and abobotulinumtoxinA in the treatment of NDO, IDO, PBS, DSD, and BOO for adults and children.

Evidence acquisition

We performed a systematic review of the published literature on PubMed, Scopus, and Embase in the English language reporting on outcomes of both BoNTA preparations. Review articles and series with <10 cases were excluded. The articles were graded for level of evidence and conclusions drawn separately for data with higher-level evidence.

Evidence synthesis

There is high-level evidence for the use of onabotulinumtoxinA and abobotulinumtoxinA in adults with NDO but only for abobotulinumtoxinA in children with NDO. Only onabotulinumtoxinA has level 1 evidence supporting its use in IDO, BOO, DSD, and PBS/interstitial cystitis.

Conclusions

We identified good-quality studies that evaluated onabotulinumtoxinA for all the indications described above in adults; such was not the case with abobotulinumtoxinA. Although this does not imply that onabotulinumtoxinA is more effective than abobotulinumtoxinA, it should be a consideration when counselling patients on the use of botulinum toxin in urologic applications. The two preparations should not be used interchangeably, either in terms of predicting outcome or in determining doses to be used.

Take Home Message

High-level evidence supports the safety of onabotulinumtoxinA in the management of both neurogenic and idiopathic detrusor overactivity; in patients having failed to respond to conservative therapy and pharmacotherapy. The evidence relating to use of onabotulinumtoxinA for benign prostatic enlargement, detrusor sphincter dyssynergia, and painful bladder syndrome remains inconclusive. Some evidence exists relating to the use of abobotulinumtoxinA for neurogenic detrusor overactivity only.

Keywords: AbobotulinumtoxinA, Bladder outflow obstruction, Botox, Botulinum toxin, Detrusor sphincter dyssynergia, Dysport, Idiopathic detrusor overactivity, Neurogenic detrusor overactivity, OnabotulinumtoxinA, Painful bladder syndrome.

Footnotes

a Sheffield Teaching Hospitals NHS Trust, Sheffield, UK

b Wake Forest University School of Medicine, Winston Salem, NC, USA

c Aristotle University of Thessaloniki, Thessaloniki, Greece

d Medical Research Council Centre for Transplantation, Urology Department, NIHR Biomedical Centre, King's College London, King's Health Partners, Guy's Hospital, London, UK

e Department of Urology and Andrology, University of Perugia, Perugia, Italy

f Department of Urology, University of Thessaly, Larissa, Greece

g Department of Urology and Andrology, Donauspital, Vienna, Austria

lowast Corresponding author. Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. H Floor, Royal Hallamshire Hospital, Glossop Rd, Sheffield, S10 2JF, UK. Tel. +44 7811337734.

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