Parcours de soin, télémédecine
Le 14/10/2021 de 14:30 à 16:00
Taux de poursuite des injections intra-détrusoriennes de toxine botulique chez les patients atteints de sclérose en plaque avec des symptômes du bas appareil urinaire : une étude rétrospective du comité français de neuro-urologie
Xavier Biardeau (Lille, France), Pierre-Luc Dequirez (Lille, France)
Objective : Main endpoint was the 5-year continuation rate associated with intra-vesical BoNTA injections. Secondary endpoints were the description of the reasons and of the risk factors for BoNTA discontinuation, and the description of bladder management after discontinuation.
Material / Patients and Methods : This retrospective multricentric study was conducted in 2019 and included 11 French teaching hospitals. All MS patients who underwent at least one intra-vesical BoNTA injection to treat refractory OAB and/or DO between 2008 and 2013 were eligible. Patients without enough data during the first 5 years were excluded.
Results : Of the 282 MS patients who underwent BoNTA injections, 196 were included. 5 years after the first injection, 81.1% were still on BoNTA treatment, while 18.9% discontinued, due to a loss of efficacy (45.9%) or difficulties in pursuing CISC (45.9%). EDSS ≥ 6 (HR 3.48 (CI: 1.51-8.02)) and progressive disease (HR 3.63 (CI: 1.56-8.46)) at the time of the first injection were significantly associated with BoNTA discontinuation. 27.7% of patients with both risk factors discontinued BoNTA. Age, gender and duration of progression since the onset of the disease were not considered risk factors. After failure, 45.9% of patients underwent a non-continent urinary diversion and 18.9% an enterocystoplasty.
Discussion - Conclusion : Intra-vesical BoNTA injections are pursued over than 5 years for a large majority of patients suffering from MS-related OAB/DO. Patients with a progressive MS and/or EDSS ≥ 6 at the time of the first injection should be advertised of the risk of BoNTA discontinuation during the following years and be prepared to consider a urinary diversion in a mid-term.
Keywords : Botulinum toxin; multiple sclerosis; overactive bladder, detrusor overactivity