Behavioral Therapy Matches Solifenacin in Treating Parkinson's OAB

In a pivotal study published in JAMA Neurology on July 14, 2025, researchers found that behavioral therapy is as effective as solifenacin (VESIcare), a commonly prescribed medication, in managing overactive bladder (OAB) symptoms among patients with Parkinson's disease (PD). The randomized noninferiority trial, involving 77 patients, aimed to evaluate the efficacy and safety of both treatment modalities over a 12-week period.

The study, led by Dr. Camille P. Vaughan, Professor and Division Director of Geriatrics and Gerontology at Emory University, involved participants who were diagnosed with PD by a movement disorder neurologist and had a symptom score of 7 or higher on the International Consultation on Incontinence Questionnaire OAB module (ICIQ-OAB). The findings indicated that both treatment groups experienced significant improvements in their OAB symptoms, with mean scores for solifenacin and behavioral therapy being 5.8 (SD, 2.4) and 5.5 (SD, 2.0) respectively (P = .02).

Importantly, the study highlighted that patients receiving solifenacin reported a higher incidence of adverse events, notably dry mouth and increased falls. Six falls were reported in the solifenacin group, while none were recorded in the behavioral therapy group, raising concerns about the risk-benefit ratio of pharmacological treatments in this vulnerable population. Dr. Vaughan emphasized the importance of considering these findings in clinical practice, particularly given the heightened risk of falls in patients with PD.

The behavioral therapy employed in the study included pelvic floor muscle training and urge suppression strategies, which were facilitated by a nurse practitioner. This approach demonstrated high adherence rates, even among participants with mild cognitive impairment, suggesting its feasibility as an initial treatment option for managing OAB symptoms.

Furthermore, researchers conducted the trial across four U.S. Veterans Affairs health care systems, ensuring a diverse participant base. Notably, baseline characteristics were balanced between the two groups, allowing for a fair comparison of outcomes. The study's design included regular assessments of adverse events every two weeks and highlighted the importance of patient-reported outcomes in evaluating treatment efficacy.

The implications of this study extend beyond clinical practice, as it may inform future guidelines for treating urinary symptoms in patients with PD. While both treatment strategies proved effective, the reduced adverse effects associated with behavioral therapy make it a compelling first-line treatment option. The authors recommended further research to explore baseline factors affecting treatment responses and the potential benefits of combining drug and behavioral therapies for patients who may not respond adequately to a single approach.

In conclusion, this study contributes valuable insights into the management of OAB symptoms in Parkinson's patients, advocating for a careful evaluation of treatment options that prioritize patient safety and quality of life. As the field of neurology continues to evolve, integrating behavioral therapies into standard care protocols could pave the way for more holistic management strategies for individuals living with Parkinson's disease.