The efficacy of antimuscarinics agents in patients with multiple sclerosis with lower urinary tract symptoms (LUTS) (PP-37)

Introduction
Multiple sclerosis (MS) causes central nervous system inflammation, leading to motor and visual issues, and commonly results in urological problems like overactive bladder (OAB). Treatments include self-catheterization, anticholinergics, and botulinum toxin, though anticholinergics can cause side effects like constipation and cognitive issues; newer drugs show promise but still raise concerns.
Method
A systematic search was conducted on April 11, 2023, across multiple databases (PubMed, Web of Science, Scopus, Embase) to evaluate the efficacy of antimuscarinic medications in MS patients with urinary problems. The search strategy identified 596 articles, which were screened by independent researchers using Rayyan.ai, with disagreements resolved by a third researcher. Relevant articles underwent data extraction, focusing on study details, medication use, and outcomes. The risk of bias was assessed using JBI's critical appraisal tools for each study type.
Results
Out of 1596 articles collected from PubMed, ISI, and Scopus, 856 remained after removing duplicates. After screening titles and abstracts, 72 articles were selected, and 14 were chosen for full-text review. A 2001 study found anticholinergics like oxybutynin effective for MS patients with bladder issues, with additional drugs used if necessary. A 2005 study on Solifenacin showed it reduced urinary symptoms but had some side effects. Cognitive impacts of anticholinergics were noted, with lower cognitive scores in users. Comparisons indicated Solifenacin was more effective than PTNS for urinary incontinence, and intravesical atropine was more effective than oral oxybutynin. Oxybutynin outperformed propantheline and mirabegron showed mixed results. Studies highlighted the effectiveness of antimuscarinics and similar improvements with mirabegron and antimuscarinics for bladder dysfunction.
Discussion and conclusions
The review evaluated antimuscarinic medications for MS-associated urinary dysfunction, highlighting their effectiveness and significant cognitive side effects. It calls for further research on their long-term cognitive impacts and notes the study's limitations in focusing solely on MS patients.