EFFICACY AND SAFETY OF TRANSDERMAL OXYBUTYNIN VERSUS ORAL OXYBUTYNIN IN THE MANAGEMENT OF PEDIATRIC NEUROGENIC BLADDER
Pediatric neurogenic bladder is a complex condition, for which oxybutynin is the gold standard pharmacotherapy. Oral medication in pediatrics can be challenging due to difficulty with administration and systemic side effects. Topical medication has a potential advantage due to ease of application and amelioration of adverse effects. This study explores our patient experience with transdermal oxybutynin patches (TOP) as a viable alternative to oral oxybutynin.
Patients with neurogenic bladder were identified through the multidisciplinary spinal rehabilitation clinic at Princess Margaret Hospital. Patients identified had trialled TOP and/or oral oxybutynin for greater than 6 weeks and were followed through the clinic. A questionnaire and rating scale was developed for patients to report efficacy, compliance and side effects. Retrospective demographics and outcomes data was collected through phone or face-to-face interview.
27 patients (mean age 10, range 4-18) met inclusion criteria, with 18 having tried both TOP and oral preparations and 9 having tried only TOP. Of the patients that had tried both formulations, 12 (66.6%) preferred TOP. Reasons cited for preference of TOP were ease of use (50%) and fewer side effects (41.7%). 6 participants preferred oral medication, reasons for preference included the patch falling off (50%) and skin irritation (33.3%). Patient- reported efficacy and compliance data was reported on a scale of 1-5. Patient reported control with TOP was 3.85 vs 3.41 with oral (p <0.1), 5 being optimal control. Compliance was reported in terms of ease of use and frequency of missed doses. TOP was missed less frequently than oral (1.89 compared to 2.59, p <0.05) and found to be easier to use (4.33 compared to 3.70, p <0.1). Of those taking oral medication, 38.9% reported systemic side effects at least ‘somewhat’ bothersome compared to only 14.8% of those using TOP. 25.9% of those using TOP reported local side effects that were at least ‘somewhat’ bothersome such as redness or itch at application site.</p>
TOP has better patient compliance and reported efficacy compared to the oral formulation in this pediatric population. For many patients, it is the preferred formulation due to ease of use and minimal side effects. The most significant limiting factors for TOP are skin irritation and the patch falling off. There were few systemic adverse effects. The data suggests that topical oxybutynin is a good alternative to oral medication in children with neurogenic bladder.