Approximately 60% of patients with overactive bladder (OAB) discontinue onabotulinumtoxinA (BTX) therapy, according to results from a real-world study presented at the International Continence Society 2020 virtual annual meeting.

Only female sex and the presence of neurogenic OAB predict BTX continuation on multivariate analysis, Ramy Goueli, MD, of the University of Texas Southwestern Medical Center in Dallas, Texas, reported during a video presentation.

Female patients had significant 3.3-fold increased odds of continuing on BTX compared with male patients. Patients with neurogenic OAB had significant 4.9% increased odds of continuing on BTX compared with patients who had idiopathic OAB.

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In his team’s study of 186 patients (mean age 54.7 years; 71.5% female; mean follow-up 6.6 years), 39% used BTX for more than 5 years. On average, patients received 8.3 self-directed intradetrusor injections of BTX during 5 years of treatment from a single surgeon because they perceived “significant benefit.” All patients had failed medical therapy at some point, but 39% were currently receiving medical therapy. At baseline, 47% were voiding, 46% performed intermittent catheterization, and 7% had an indwelling catheter.

Dr Goueli’s team found no urodynamic factors, symptom scores, or specific neurologic diagnosis that predicted BTX continuation.

Of the patients in the cohort, 73% had neurogenic OAB and 27% had idiopathic OAB. The BTX attrition rate at 5 years was 43.7% among patients with neurogenic OAB and 25.5% among patients with idiopathic OAB. Male patients with idiopathic OAB had the highest BTX attrition rate: 90% after 1 year.

“This study shows that females and patients diagnosed with neurogenic overactive bladder had an increased likelihood of continuing therapy with BTX for at least 5 years,” Dr Goueli stated.


Goueli R, Hong J, Rodriguez D, Lemack G. Attrition rates and predictors of long-term (>5 year) continuation treatment with onabotulinumtoxinA intradetrusor injections. Presented at: ICS 2020 Online, November 19-22, 2020. Presentation 232.