Tolterodine versus oxybutynin in the treatment of urge urinary incontinence: A meta-analysis

OBJECTIVE: To compare tolterodine with oxybutynin in treatment of urge inco ntinence. STUDY DESIGN: A systematic review, following Cochrane methods, was performe d to retrieve results of randomized trials that compared tolterodine with o xybutynin in adults with urge incontinence, Composite point estimates of ef ficacy (episodes of incontinence per 24-hour period, frequency, and voided volume) and safety (dry mouth, withdrawal, and dose modification) were calc ulated. RESULTS: Four studies were included. Both drugs similarly decreased the num ber of micturitions in a 24-hour period. Oxybutynin was marginally superior to tolterodine in decreasing the number of incontinent episodes in a 24-ho ur period (weighted mean difference, 0.41; 95% confidence interval [CI], 0. 04 to 0.77) and increasing the mean voided volume per micturition (8.24 mL; 95% CI, 14.19 to 3.38). Fewer patients had dry mouth (relative risk, 0.54; 95% CI, 0.48 to 0.61) and withdrew from the study because of side effects (relative risk, 0.63; 95% CI, 0.46 to 0.88) with tolterodine. CONCLUSIONS: Oxybutynin and tolterodine share a clinically similar efficacy profile (although oxybutynin is statistically superior), but tolterodine i s better tolerated and leads to fewer withdrawals as a result of adverse ev ents.