Patient Factors Associated With Onabotulinum Toxin A Treatment Outcome in Women With Detrusor Overactivity

Objective: To evaluate potential predictors of non-response to treatment with 200U onabotulinum toxin A(onaBoNTA) in women with refractory detrusor overactivity ( DO). Subjects and Methods: A secondary analysis of a randomized trial of 200U onaBoNTA versus placebo in women with refractory DO analyzed baseline and 6 week follow-up data. Univariate and multivariate logistic regression were used to assess demographic factors and baseline clinical parameters on non-response to treatment defined as 20% or less improvement in urinary urgency and leakage episodes, 10% or less in voiding frequency, not achieving continence, and "no change'' or worse on PGI-I score at 6 weeks. Results: One Hundred and twenty-two women were included. Twenty-nine ( 23.8%), 24 ( 19.7%), and 19 ( 15.6%) were non-responders to treatment for urgency, voiding, and leakage episodes, respectively. Fifty-nine ( 48.4%) failed to achieve continence, and 28 ( 23%) were non-responders on the PGI-I scale. Smoking status ( OR: 2.89 95%CI 1.08, 7.73, P = 0.034) predicted non-response in urgency episodes, and higher baseline leakage episodes ( OR: 1.17 95% CI 1.04, 1.31, P = 0.007) predicted non-response in achieving continence. Increasing age ( OR 1.04, 95% CI 1.0, 1.09, P = 0.063) and body mass index ( BMI) ( OR 1.07, 95% CI 1.0, 1.16, P = 0.065) showed marginal associations with non-response on the PGI-I scale. Conclusion: onaBoNTA is an effective treatment for refractory DO, but some fail to respond. For identification of women at risk, our data indicate smokers should be advised of a lesser chance of successful treatment. Older women, those with high BMI and with more severe leakage also have a higher risk of failure. (C) 2016 Wiley Periodicals, Inc.