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    CNS may be path to future voiding dysfunction therapies

    While a number of medical and non-medical therapies are available to treat overactive bladder, underactive bladder, bladder outlet obstruction, and bladder pain syndrome, the search continues for therapeutic options that raise the bar of efficacy and safety. In this interview, Karl-Erik Andersson, MD, PhD, discusses current treatments for these common voiding dysfunctions and future directions, including central nervous system agents and combination therapies. Dr. Andersson is professor of urology at Wake Forest School of Medicine, Winston-Salem, NC. He is also a Jens Christian Skou fellow at Aarhus University, Aarhus, Denmark. Dr. Andersson was interviewed by Urology Times Editorial Consultant Philip M. Hanno, MD, MPH, professor of urology at the University of Pennsylvania, Philadelphia. 


    I’d like to discuss the management of several common voiding dysfunctions, starting with overactive bladder. What is the current state of therapy using oral medications, and how can we expect our oral therapy options to change in the future?   

    The current first-line therapies are various antimuscarinic drugs and the beta-3 receptor agonist mirabegron (Myrbetriq). There may be changes in the proportion of people treated first with antimuscarinic drugs or the beta-3 agonist, but for the next 5 years at least, these two drug classes will be first-line pharmacologic therapy. There are possibilities to treat those who do not respond to these two types of treatment with botulinum toxin (Botox).

    Related - Underactive bladder: Definition, diagnosis, and treatment

    If we look at what’s in the pipeline, there are very few new drug principles. There are a couple of new antimuscarinic drugs in development, but they don’t appear to have any specific properties that would make them better than the ones we have. Since we have such a low number of established and accepted drugs, I think we have to use combinations. One of the combinations in the pipeline is the antimuscarinic solifenacin succinate (VESIcare) plus mirabegron, which is currently in phase III trials. We will likely see that drug combination on the market within the next few years.

    Next: "Looking outside what is recommended by the regulatory authorities, a lot of drugs are used to treat OAB."

    Philip M. Hanno, MD, MPH
    Philip M. Hanno, a Urology Times editorial consultant, is professor of urology at the University of Pennsylvania, Philadelphia.


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