Comparative efficacy and tolerability of solifenacin 5mg/day versus other oral antimuscarinic agents in overactive bladder: A systematic literature review and network meta-analysis

AimsTo compare efficacy and tolerability of solifenacin 5mg/day versus other oral antimuscarinic agents for the treatment of overactive bladder (OAB). MethodsLiterature searches of MEDLINE, Embase, and the Cochrane Library were undertaken to identify randomized controlled trials in OAB (2000-2015) for antimuscarinic agents. A network meta-analysis (NMA) was performed to estimate efficacy and tolerability outcomes for solifenacin 5mg/day relative to other antimuscarinics. ResultsThe NMA included 53 eligible trials (published, n=48; unpublished on search date, n=5). Solifenacin 5mg/day was significantly more effective than tolterodine 4mg/day for reducing incontinence and urgency urinary incontinence (UUI) episodes, but significantly less effective than solifenacin 10mg/day for micturition; no other statistically significant differences were noted for efficacy. Solifenacin 5mg/day had a statistically significant lower risk of dry mouth compared with darifenacin 15mg/day, fesoterodine 8mg/day, oxybutynin extended-release 10mg/day, oxybutynin immediate-release (IR) 9-15mg/day, tolterodine IR 4mg/day, propiverine 20mg/day, and solifenacin 10mg/day. There were no significant differences between solifenacin 5mg/day and other antimuscarinics for risk of blurred vision, or for 11 of 17 active comparators for risk of constipation. ConclusionsThis NMA suggests that the efficacy of solifenacin 5mg/day is at least similar to other common antimuscarinics across the spectrum of OAB symptoms analyzed, and is more effective than tolterodine 4mg/day in reducing incontinence and UUI episodes. Solifenacin 5mg/day has a lower risk of dry mouth compared with several agents.