Background
The aim of this study was to assess long‐term efficacity of botulinum neurotoxin A (BoNT‐A) in the treatment of neurogenic detrusor overactivity (NDO).
Materials and Methods
This was a retrospective monocentric study in a reference center. We included patients who received intradetrusor BoNT‐A for NDO between 2001 and 2015. The focus of our analysis was on patients defined as “good responders” (≥ 5 injections of intradetrusor BoNT‐A over a period of ≥5 years). The primary endpoint was the evaluation of long‐term efficacity of BoNT‐A. Recurrent NDO was monitored by the use of cystomanometry before the first injection and 1 month after each injection.
The secondary objective was to assess the influence of NDO's etiology, age, and sex on the long‐term efficacity of the treatment.
Results
A total of 107 patients were included (60.7% with spinal cord injury [SCI] and 36.4% with multiple sclerosis [MS]). The mean follow‐up period was 83.7 months (66; 120). The mean number of injections was of 8.9 (5; 21). A total of 67.3% (n = 72) of patients were still controlled by treatment at the end of their follow‐up period. Therapeutic failure occurred in 30 patients (26.1%) with a cessation of BoNT‐A treatment at 76 months on average (median: 82.5 months). There was no significant impact of age (P = .42), sex (P = .35), or NDO's etiology (MS vs SCI; P = .54) on long‐term efficacy of BoNT‐A treatment.
Conclusion
The results of our study indicate that the application of BoNT‐A seems to be an effective and durable treatment in a large number of neurogenic patients after more than 10 years of follow‐up. However, botulinum toxin tolerance occurred in approximately 25% of patients.