From the Guidelines
Axonics is typically recommended as the more effective and better tolerated option for sacral neuromodulation therapy. Both Interstim and Axonics are generally effective and well-tolerated, but Axonics may have a slight edge overall. According to the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1, sacral neuromodulation is a recommended treatment option for patients with OAB who have an inadequate response to, or have experienced intolerable side effects from, pharmacotherapy or behavioral therapy.
Key Considerations
- The Axonics system uses a smaller, longer-lasting rechargeable device that is MRI compatible up to 3 Tesla, which may provide more convenience and flexibility for patients.
- The Axonics system can last up to 15 years before needing replacement, compared to 3-5 years for Interstim, which may reduce the need for repeat procedures and improve patient satisfaction.
- Patients often report less discomfort with the smaller Axonics implant, and its constant current stimulation may provide more consistent symptom relief compared to Interstim's constant voltage approach.
- The choice between devices should be made in consultation with a urologist or urogynecologist, considering the patient's specific condition, anatomy, and preferences.
Important Factors
- Both systems require a trial period before permanent implantation to assess effectiveness.
- Proper patient selection and follow-up care are crucial for optimal outcomes with either device.
- The AUA/SUFU guideline emphasizes the importance of individualized therapy approaches in patients with OAB, taking into account patient preferences and values 1.
From the Research
Comparative Efficacy of InterStim and Axonics Sacral Nerve Stimulation
- The provided studies do not directly compare the efficacy of InterStim (Sacral Nerve Stimulation) versus Axonics (Sacral Nerve Stimulation) 2, 3, 4, 5, 6.
- However, the studies suggest that both InterStim and Axonics Sacral Nerve Stimulation systems are effective in treating urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence 3, 4, 5, 6.
- The Axonics Sacral Neuromodulation System has been shown to provide sustained clinically significant improvements in overactive bladder subjects after 1-year, with 94% of test responders continuing to respond to therapy 6.
- The Axonics system also has the potential advantage of reducing the frequency of surgical replacement procedures and associated complications due to its rechargeable battery, which is estimated to last for at least 15 years 4, 5.
Tolerability of InterStim and Axonics Sacral Nerve Stimulation
- The studies suggest that both InterStim and Axonics Sacral Nerve Stimulation systems are generally well-tolerated, with most adverse events being related to the implantation procedure or device-related complications 3, 4, 5, 6.
- The Axonics system has been shown to have a low rate of device-related adverse events, with 21% of subjects experiencing discomfort due to stimulation, which was resolved with reprogramming in all instances 6.
- The rechargeable nature of the Axonics system may also reduce the risk of complications associated with repeated surgical replacement procedures 4, 5.
Cost-Effectiveness of InterStim and Axonics Sacral Nerve Stimulation
- The studies suggest that the Axonics Sacral Neuromodulation System may be cost-effective in the long-term, with estimated cost savings of £6025 per person over a 15-year period compared to a non-rechargeable system 4.
- However, the cost-effectiveness of InterStim versus Axonics Sacral Nerve Stimulation is not directly compared in the provided studies 2, 3, 4, 5, 6.