Drug costs a factor
Some patients, he adds, will still have pronounced symptoms. For them, combination treatment with alpha blockers and anticholinergics may be appropriate. “I also think it’s important to talk to patients about what their drug plans will cover; there’s no point in putting patients on a drug that’s going to cost $50 a month if they can’t afford it. Physicians and patients also should discuss the fact that symptoms can fluctuate.”
Dr. Staskin points out that women with OAB and men with OAB who are not obstructed will have the same symptoms, and both will respond to anticholinergic therapy. “In the past, anticholinergic drugs were thought to be unsafe in men. The presumption was that men would go into urinary retention because the prostate was blocking the urethra,” Dr. Staskin says. “Now we’ve changed our minds somewhat; we don’t think the drugs affect contractility as much as we used to. Data shows that if you’ve treated obstruction with alpha blockers or 5-alpha-reductase inhibitors, you can add an anticholinergic. Studies suggest that men with smaller prostates do better on combination therapy.”
What’s in the pipeline?
Severe OAB cases that resist all available conventional treatments present a therapeutic dilemma, but promising new therapies are under investigation. Michael Chancellor, MD, at the University of Pittsburgh, has reported good results injecting botulinum toxin into the base of the bladder. Use of the toxin for OAB is not yet FDA approved, however.