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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 張尚仁 | 以藥物治療女性急迫性尿失禁的好處與壞處 | 2014/3/28 上午 09:20:41 | 0 |
| 原 文 | 題 目 | benefits and harms of pharmacologic treatment for urinary incontinence in women: a systemic review |
| 作 者 | Shamliyan T1, Wyman JF, Ramakrishnan R, Sainfort F, Kane RL. | |
| 出 處 | Ann Intern Med 2012; 156:861-874 | |
| 出版日期 | 2012 | |
| 評 論 | 門診常常會有急迫性尿失禁的婦女病患求診，有一部分的病人覺得行為治療效果不佳又不願意接受手術治療，因此要求藥物治療。內科雜誌(Ann Intern Med)做了一個後設研究(meta-analysis)和文獻回顧發現藥物治療(包含了:darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, trospium)和安慰劑相比，雖然稍微可以降低尿失禁的次數及嚴重度(平均每一千位服用藥物的病人有兩百個病人受益)。 而且這幾種藥物用於治療急迫性尿失禁並沒有明顯藥效差距。但是由於藥物的副作用緣故，加上這些老病人大多服用許多其他藥物，因此大部分的病人藥物順從性並不好也不會持續的服用藥物。所以文獻回顧並沒有以藥物治療尿失禁療效與副作用的長期資料。臨床給予這些同時使用多種藥物的老病人藥物治療需多加注意藥物的交互作用，避免產生嚴重併發症。 | |
| abstract |
BACKGROUND: Urinary incontinence (UI) in women adversely affects quality of life. PURPOSE: To conduct a systematic literature review of drugs for urgency UI in women. DATA SOURCES: MEDLINE, the Cochrane Central Register of Controlled Trials, SCIRUS, and Google Scholar were searched for articles published from 1966 to November 2011. STUDY SELECTION: Randomized, controlled trials (RCTs) reported in English. DATA EXTRACTION: Rates of outcomes and risk of bias were extracted by using a standardized form to pool absolute risk differences and calculate the number of attributable events per 1000 patients treated, with 95% CIs. DATA SYNTHESIS: 94 RCTs were eligible. Pooled analyses showed that among drugs for urgency UI, per 1000 treated women, continence was restored in 130 with fesoterodine (CI, 58 to 202), 85 with tolterodine (CI, 40 to 129), 114 with oxybutynin (CI, 64 to 163), 107 with solifenacin (CI, 58 to 156), and 114 with trospium (CI, 83 to 144). Rates of treatment discontinuation due to adverse effects were 31 per 1000 treated with fesoterodine (CI, 10 to 56), 63 with oxybutynin (CI, 12 to 127), 18 with trospium (CI, 4 to 33), and 13 with solifenacin (CI, 1 to 26). The studies' inconsistent definitions of reduction in UI and quality of life hampered synthesis of evidence.LIMITATION: Evidence for quality-of-life improvements and comparative effectiveness with drugs was limited, and evidence for the effects of race, baseline severity of UI, and comorbid conditions on treatment success was insufficient. CONCLUSION: Overall, drugs for urgency UI showed similar small benefit. Therapeutic choices should consider the harms profile. Evidence for long-term adherence and safety of treatments is lacking. |
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