Botulinum toxins, from wrinkles to bladder

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Scott Whitcup, Allergan's Executive Vice President, Research and Development, Chief Scientific Officer

Researchers have been in fact often able to turn in our favor proteins from which it is better to stay away. It is the case of botulinum toxin which, just to name the most famous use, “rejuvenate” every year the appearance of an always increasing number of people. In addition to the famous Botox, Clostridium botulinum toxins have been studied and applied with success for the treatment of numerous pathologies. The last in order of time is the overactive bladder. A disorder that causes sudden ran to the bathroom to thirty million people in the U.S. alone

Eros Fabrizi

Recently the U.S. Food and Drug Administration expanded the approved use of Botox® (onabotulinumtoxinA) to treat adults with overactive bladder who cannot use or do not adequately respond to a class of medications known as anticholinergics. Overactive bladder is a condition in which the bladder squeezes too often or squeezes without warning.

Symptoms include leaking urine (urinary incontinence), feeling the sudden and urgent need to urinate, and frequent urination. When Botox is injected into the bladder muscle, it causes the bladder to relax, increasing the bladder’s storage capacity and reducing episodes of urinary incontinence. Injecting the bladder with Botox is performed using cystoscopy, a procedure that allows doctors to visualize the interior of the bladder while Botox is being injected. Botox ’s safety and efficacy for this new indication were established in two clinical trials of 1,105 patients with symptoms of overactive bladder. Patients were randomly assigned to receive injections of 100 units of Botox (20 injections of 5 units each) or placebo. Results after 12 weeks showed that patients treated with Botox experienced urinary incontinence an average of 1.6 to 1.9 times less per day than patients treated with placebo. Botox-treated patients also needed to urinate on average 1.0 to 1.7 times less per day and expelled an average of about 30 milliliters more urine than those treated with placebo. Treatment with Botox can be repeated when the benefits from the previous treatment have decreased, but there should be at least 12 weeks between treatments. Common side effects reported during clinical trials included urinary tract infections, painful urination, and incomplete emptying of the bladder (urinary retention). Patients who develop urinary retention may need to use a catheter until the urinary retention resolves. Patients being treated for overactive bladder with Botox should not have a urinary tract infection and should take antibiotics before, during, and for a few days after Botox treatment to lower the chance of developing an infection from the procedure.

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