A Cochrane review included 61 trials (42 parallel-group designs, 19 crossover trials), with 11 956 subjects. Most trials were double-blind but variable in other aspects of quality. Nine medications were tested: darifenacin; emepronium bromide or carrageenate; oxybutynin; propiverine; propantheline; tolterodine (one trial with slow release formulation); trospium chloride; and solifenacin.
At the end of the treatment period, cure or improvement (relative risk [RR] 1.39, 95% CI 1.28 to 1.51), difference in leakage episodes in 24 hours (weighted mean difference [WMD] –0.54; 95% CI –0.67 to –0.41) and difference in number of voids in 24 hours (WMD –0.69; 95% CI –0.84 to –0.54) were statistically significant favouring medication. Statistically significant but modest sized improvements in quality of life scores were reported in recently completed trials. There was three times the rate of dry mouth in the medication group (RR 3.00 95% CI 2.70 to 3.34) but no statistically significant difference in withdrawal (RR 1.11, 95% CI 0.91 to 1.36). Sensitivity analysis, while limited by small numbers of trials, showed little likelihood that these effects were modified by age, sex, diagnosis, or choice of drug.
Another Cochrane review (abstract , review ) included 23 trials involving a total of 3 685 participants. The duration of follow up varied from two to 52 weeks. During 3 to 12 weeks of treatment, symptomatic improvement was more common amongst those on anticholinergic drugs compared with bladder training (RR 0.74; 95% CI 0.61 to 0.91; 7 small trials). The data favoured combination of anticholinergics with bladder training compared with bladder training alone (RR 0.57; 95% Cl 0.38 to 0.88; 3 small trials) or anticholinergics alone (RR for improvement 0.80; 95% CI 0.62 to 1.04; 3 small trials). Adverse effects, such as dry mouth, were reported by around a third of those taking anticholinergics.