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Long term continuation with repeated Botulinum toxin A injections in people with neurogenic detrusor overactivity after spinal cord injury

Abstract

Study design

Retrospective chart study.

Objectives

The aim was to examine continuation of treatment of individuals with spinal cord injury including myelomeningocele and neurogenic detrusor overactivity, treated with repeated intra-detrusor Botulinum toxin A injections, and to investigate factors associated with discontinuation of treatment.

Setting

Rigshospitalet, Denmark

Methods

This study included 128 individuals with spinal cord injury and neurogenic detrusor overactivity, who were offered repeated Botulinum toxin A injections between 2001 and 2018. Continuation rates of the treatment were estimated using Kaplan Meier analysis. A Cox proportional hazard analysis was used to investigate factors predictive of discontinuation.

Results

A total of 1156 treatments were performed. The median number of treatments was six (IQR 9, range 1−51), and median follow-up was 10.6 years (IQR 8.5, range 0−16.9). All urodynamic parameters changed significantly after the first treatment (p < 0.001). The continuation group had significantly higher mean maximum bladder capacity after the first injections compared with the discontinuation group, with a mean difference between the groups of 84.5 mL (95% CI 4.7–164.2) (p = 0.038). The probability of continuing treatments after 5 years was 59% (95% CI 50.0–67.8) and 50% (95% CI 40.1–59.3) after 10 years. Individuals aged 31–50 years were more likely to continue treatment compared with those aged >50 years (95% CI 0.21‒0.79) (p = 0.008). No other factors predicted discontinuation.

Conclusions

This long-term follow-up study showed that 50% of people with spinal cord injury starting intra-detrusor Botulinum toxin A for neurogenic detrusor overactivity are still receiving injections after 10 years.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Affiliations

Authors

Contributions

KPH was responsible for collecting data, analyzing and interpreting data, and writing the report. NK was responsible for designing the protocol, contributed to analyzing and interpreting data, and revised the article critically. PB and FBS was responsible for designing the protocol, interpreting data, and revised the article critically. ME was responsible for designing and writing the protocol, interpreted and analyzed the data, conducted the Cox proportional Hazard analysis, and revised the article critically.

Corresponding author

Correspondence to Katrine P. Hebert.

Ethics declarations

Ethical approval

The study was approved by the Danish data protection agency and the Danish patient safety authority. We certify that all applicable institutional and governmental regulations concerning the ethical use of data originally collected for clinical purposes were followed during the course of this research.

Conflict of interest

NK and KPH have received travel grants from Contura. ME has received honoraria and travel grants from Contura. However, Contura had no involvement in the collection, analysis, interpretation, or write up of this paper. PB and FBS have no disclosures to declare.

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Hebert, K.P., Klarskov, N., Bagi, P. et al. Long term continuation with repeated Botulinum toxin A injections in people with neurogenic detrusor overactivity after spinal cord injury. Spinal Cord 58, 675–681 (2020). https://doi.org/10.1038/s41393-019-0411-0

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