OBJECTIVES: Neurogenic detrusor overactivity (NDO) causes urinary incontinence (UI). AbobotulinumtoxinA (ABO) and onabotulinumtoxinA (ONA) reduce frequency of weekly UI episodes. The objective was to compare efficacy and safety of ABO with ONA in NDO.

METHODS: The systematic literature review followed Cochrane and NICE guidance. MEDLINE and other sources were searched for randomised controlled trials of botulinum toxins-A (August 2020). Results from two phase 3 ABO trials were included. Outcomes included mean change from baseline (CFB) in weekly UI episodes (2, 6, 12, 24 weeks); proportion of patients with 100% reduction in UI episodes at 6 weeks; treatment-emergent urinary tract infections (TE-UTI). Bucher indirect treatment comparisons (ITC) were conducted.

RESULTS: Six studies on three active interventions (ABO 600U, 800U, and ONA 200U) were included in the ITC, connected via the comparator placebo. Trends were consistent although not significant. ABO 600U had numerically greater reduction in weekly UI episodes versus ONA, with mean (95%CI) differences in CFB of -0.8 (-6.0, 4.5) and -2.3 (-8.5, 3.9) at 6 and 12 weeks, respectively. At 6 weeks, ABO 600U had numerically greater odds of a 100% reduction in weekly UI episodes versus ONA (odds ratio: 3.0 [95%CI: 0.60, 15.34]). Results were similar for ABO 600U and 800U. Applying relative effect estimates to a common/average placebo anchor rate led to estimates, at 6 weeks, of 54.5%, 45.9% and 28.4% of patients receiving ABO 600U, 800U and ONA 200U, respectively, in achieving 100% reduction in weekly UI episodes. ABO 600U/800U was associated with less TE-UTIs than ONA 200U (odds ratios: 0.64 [0.34, 1.21] and 0.90 [0.48, 1.66], respectively).

CONCLUSIONS: ABO and ONA offer significant efficacy in NDO, with improvement on ABO numerically greatest, and difference in CFB between the two toxins increasing from week 6 to 12. Further studies are needed for better powered comparisons that may find statistically significant differences.