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Considerations and guidance for using BOTOX® as a treatment option for managing neurogenic detrusor overactivity (NDO)*

Spectrum of treatments for NDO5,6

Adapted from EAU Guidelines 2022 and NICE Guidelines 20125,6


Botulinum toxin injection is a recommended option in the ICI and NICE guidelines6,7

Offer bladder wall injection with botulinum toxin type A to adults:6

• With spinal cord disease (for example, spinal cord injury or multiple sclerosis) and

• With symptoms of an overactive bladder and

• In whom antimuscarinic drugs have proved to be ineffective or poorly tolerated


BoNT/A: botulinum toxin type-A; ICI: International Consultation on Incontinence; NDO: neurogenic detrusor overactivity; NICE: National Institute for Health and Care Excellence.

*BOTOX® (botulinum toxin type A) is indicated for management of bladder dysfunctions in adult patients who are not adequately managed with anticholinergics: neurogenic detrusor overactivity with urinary incontinence due to subcervical spinal cord injury (traumatic or non-traumatic), or multiple sclerosis.8

NICE guidance:6

• Offer bladder wall injection with botulinum toxin type A to adults:

• with spinal cord disease (for example, spinal cord injury or multiple sclerosis) and

• with symptoms of an overactive bladder and

• in whom antimuscarinic drugs have proved to be ineffective or poorly tolerated

• Before offering bladder wall injection with botulinum toxin type A: 

• explain to the person and/or their family members and carers that a catheterisation regimen is needed in most people with neurogenic lower urinary tract dysfunction after treatment, and

• ensure that they are able and willing to manage such a regimen should urinary retention develop after the treatment

 

NICE [2012] Urinary incontinence in neurological disease. Available from nice.org.uk. All rights reserved. Subject to Notice of rights (link to: https://www.nice.org.uk/terms-and-conditions#notice-of-rights)

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

 

References

  1. Allergan. Data on file. INT/0423/2016
  2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011;51(9):1358-1373
  3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018;19(1):13
  4. Allergan. Data on file. 014
  5. European Association of Urology Guidelines in neurological disease. Available at: https://uroweb.org. Accessed April 2022
  6. National Institute for Health and Care Excellence (NICE). NICE guideline 148. Urinary incontinence in neurological disease. Available at: www.nice.org.uk. Accessed April 2022
  7. Abrams P et al. Incontinence: 6th Edition 2017;ISBN:978-0-9569607-3-3:pp1148
  8. BOTOX® Summary of Product Characteristics. Available at: www.medicines.org.uk. Accessed April 2022

Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.

 

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/

Adverse events should also be reported to AbbVie on GBPV@abbvie.com 

 

Date of preparation: April 2022. UK-BUO-220034.