(HealthDay News) — Intradetrusor injection of onabotulinumtoxin A is safe and effective for bladder chemodenervation in overactive bladder, with new approaches being developed to increase toxin permeability and avoid intradetrusor injections, according to a review published in the April issue of The Journal of Urology.

Pradeep Tyagi, PhD, from the University of Pittsburgh, and colleagues conducted a systematic review of studies of onabotulinumtoxin A in the treatment of neurogenic bladder and refractory idiopathic overactive bladder.

The researchers found that for treatment of overactive bladder, the safety and efficacy of intradetrusor injection of onabotulinumtoxin A is sensitive to injection volume and depth, triggering study on injection-free modes of drug delivery into the bladder. In order to increase toxin permeability and avoid intradetrusor injections, urothelial denudation with protamine sulfate or dimethyl sulfoxide, liposome encapsulated onabotulinumtoxin A, and other physical approaches are being studied. A multicenter placebo controlled trial was conducted to examine the safety and efficacy of liposome encapsulated onabotulinumtoxin A; this treatment reduced urinary frequency and urgency but did not reduce urgency urinary incontinence episodes.

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“Further studies are needed to develop better drug delivery platforms that overcome the drawbacks of intradetrusor injection, increase patient acceptance, and reduce treatment costs,” the authors write.

Two authors disclosed financial ties to the biopharmaceutical industry.

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  1. Tyagi P, Kashyap M, Yoshimura N, et al. Past, Present and Future of Chemodenervation with Botulinum Toxin in the Treatment of Overactive Bladder. J Urol. 18 November 2016. doi: 10.1016/j.juro.2016.11.092