Behavioral Therapy Proves as Effective as Solifenacin for Overactive Bladder in Parkinson’s Disease

A Randomized trial Highlights the Benefits of Pelvic Floor Muscle Exercises

Parkinson’s disease (PD), a progressive neurodegenerative disorder, frequently enough presents with a range of non-motor symptoms, including overactive bladder (OAB). OAB can significantly impact a patient’s quality of life, leading to urinary urgency, frequency, and nocturia. While pharmacotherapy, such as solifenacin, is a common treatment, a recent randomized noninferiority trial published in JAMA Neurology suggests that pelvic floor muscle exercise-based behavioral therapy offers comparable effectiveness with a potentially better safety profile, particularly for individuals with PD.

Comparing Behavioral Therapy and Drug Therapy for OAB in Parkinson’s Disease

The study, conducted by Vaughan et al., aimed to determine if behavioral therapy was noninferior to solifenacin in treating OAB symptoms in individuals with Parkinson’s disease. The findings indicate that behavioral therapy is a viable and effective alternative to drug therapy,offering a comparable reduction in OAB symptoms.This is a crucial finding for a patient population that frequently enough experiences increased fall risk, a side effect associated with anticholinergic medications like solifenacin.

Solifenacin Use and Adverse Events in the Trial

In the solifenacin group, the study observed a low dropout rate due to treatment-emergent adverse events (AEs), with only 4 participants discontinuing the medication. Of these, one dropout was directly attributed to AEs. Importantly, a larger number of participants (19.5%) requested to stop the drug therapy due to treatment-emergent AEs but continued in the trial for outcome assessments.Furthermore, a notable percentage of patients (22%) on solifenacin opted to increase their dosage to 10 mg daily at the 6-week mark due to inadequate symptom control, suggesting potential limitations in efficacy for some individuals at the standard dose.

Cognitive Function and Treatment Response

Exploratory analyses within the study investigated the impact of cognitive function on treatment outcomes. The Montreal Cognitive Assessment (moca) was used to measure cognitive function. The results indicated no statistically notable difference in the 12-week OAB symptom score based on the level of cognitive function. This suggests that behavioral therapy might potentially be a suitable initial treatment approach even for individuals with PD and mild cognitive dysfunction, a common comorbidity.

Study Limitations and Future Directions

The researchers acknowledged certain limitations in their study, including a relatively short follow-up period. However, they noted that this duration aligns with previous trials for urinary symptoms.Another limitation was the predominantly male participant group,which may affect the generalizability of the findings to women with PD. Despite some differential dropout in the drug therapy group, missing data were minimal, with only four participants exiting the study early.

Future research is recommended to focus on identifying baseline factors that influence treatment response and to explore the potential benefits of combining drug and behavioral therapies for patients who do not respond adequately to a single approach.

Expert Commentary: A Shift Towards Behavioral Interventions

Vaughan et al. concluded that their randomized noninferiority trial provides evidence for the effectiveness of pelvic floor muscle exercise-based behavioral therapy, demonstrating its comparability to drug therapy for common urinary symptoms in persons with PD. The observed increase in falls within the solifenacin group underscores the critical need for a careful risk-benefit assessment when prescribing medications for urinary symptoms, especially considering the inherent increased fall risk in individuals with PD. Given the potential adverse effects and burden associated with drug therapy, these findings strongly suggest that behavioral therapy could serve as a beneficial initial treatment strategy, even for those with Parkinson’s disease and mild cognitive impairment.

references:

1. Vaughan CP, Morley JF, Lehosit J, McGwin G, Muirhead L, Khakharia A, Johnson TM 2nd, Evatt ML, Sergent T, Burgio KL, Markland AD. Behavioral Compared With Drug Therapy for Overactive Bladder Symptoms in Parkinson Disease: A Randomized Noninferiority Trial. JAMA Neurol. 2025 Jul 14:e251904. doi: 10.1001/jamaneurol.2025.1904. Epub ahead of print. PMID: 40658410; PMCID: PMC12261112.
2. Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L