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Antimuscarinic Medication Use in Elderly Patients with Overactive Bladder

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Abstract

Background

Antimuscarinic medications are the first-line pharmacological treatment for overactive bladder (OAB); however, little is known about the utilization pattern of antimuscarinic agents in elderly patients with OAB.

Objective

This study examined the prevalence and predictors of antimuscarinic medication prescribing in elderly patients with OAB, using national ambulatory survey data.

Methods

This cross-sectional study utilized the 2009–2010 National Ambulatory Medical Care Survey and the outpatient component of the National Hospital Ambulatory Medical Care Survey. The study included patients aged ≥65 years diagnosed with OAB based on the International Classification of Diseases. Antimuscarinic medications were operationally defined using the American Hospital Formulary Service classification and identified using Multum Lexicon codes. Descriptive statistics using sampling weights were used to estimate the prevalence of antimuscarinic medication prescription, while multivariable logistic regression within the conceptual framework of the Anderson Behavioral Model was used to identify the factors associated with antimuscarinic medication prescription in elderly patients with OAB.

Results

According to the national surveys, 2.18 million (95 % confidence interval [CI] 1.62–2.75) elderly outpatient visits were made for OAB, of which 0.90 million (41.43 %) visits involved prescribing of antimuscarinic medications. The most frequently prescribed drugs were solifenacin (14.25 %), oxybutynin (10.50 %), and tolterodine (6.89 %). Multivariable analysis revealed that patients ≥85 years of age (odds ratio [OR] 3.50, 95 % CI 1.23–9.92) were more likely to receive antimuscarinic medications, and the South region (OR 2.78, 95 % CI 1.01–7.66) increased the likelihood of receiving antimuscarinic medications in elderly patients with OAB.

Conclusions

This study found that antimuscarinic medications are commonly prescribed for elderly patients with OAB and there is variation in antimuscarinic use across age and region.

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References

  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.

    Article  PubMed  Google Scholar 

  2. Abrams P, Kelleher CJ, Kerr LA, Rogers RG. Overactive bladder significantly affects quality of life. Am J Manag Care. 2000;6(11 Suppl):S580–90.

    CAS  PubMed  Google Scholar 

  3. Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36.

    CAS  PubMed  Google Scholar 

  4. Hobbs F, Stoops N. Demographic trends in the 20th century. Washington, DC: US Bureau of the Census; 2002.

    Google Scholar 

  5. Ganz ML, Smalarz AM, Krupski TL, Anger JT, Hu JC, Wittrup-Jensen KU, et al. Economic costs of overactive bladder in the United States. Urology. 2010;75(3):526–532, 532.e1–18.

  6. Nygaard I. Clinical practice. Idiopathic urgency urinary incontinence. N Engl J Med. 2010;363(12):1156–62.

    Article  CAS  PubMed  Google Scholar 

  7. Arnold J, McLeod N, Thani-Gasalam R, Rashid P. Overactive bladder syndrome: management and treatment options. Aust Fam Phys. 2012;41(11):878–83.

    Google Scholar 

  8. Marinkovic SP, Rovner ES, Moldwin RM, Stanton SL, Gillen LM, Marinkovic CM. The management of overactive bladder syndrome. BMJ. 2012;344:e2365.

    Article  PubMed  Google Scholar 

  9. Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al; American Urological Association; Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455–63.

  10. Chess-Williams R. Muscarinic receptors of the urinary bladder: detrusor, urothelial and prejunctional. Auton Autacoid Pharmacol. 2002;22(3):133–45.

    Article  CAS  PubMed  Google Scholar 

  11. Feinberg M. The problems of anticholinergic adverse effects in older patients. Drugs Aging. 1993;3(4):335–48.

    Article  CAS  PubMed  Google Scholar 

  12. Kay GG, Granville LJ. Antimuscarinic agents: implications and concerns in the management of overactive bladder in the elderly. Clin Ther. 2005;27(1):127–38.

    Article  CAS  PubMed  Google Scholar 

  13. Odeyemi IA, Dakin HA, O’Donnell RA, Warner J, Jacobs A, Dasgupta P. Epidemiology, prescribing patterns and resource use associated with overactive bladder in UK primary care. Int J Clin Pract. 2006;60(8):949–58.

    Article  CAS  PubMed  Google Scholar 

  14. Altman D, Granath F, Mattiasson A, Falconer C. Anticholinergic drug use for overactive bladder in Sweden: a nationwide pharmacoepidemiological study. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(11):1285–91.

    Article  PubMed  Google Scholar 

  15. Ju R, Garrett J, Wu JM. Anticholinergic medication use for female overactive bladder in the ambulatory setting in the United States. Int Urogynecol J. 2014;25(4):479–84.

    Article  PubMed  Google Scholar 

  16. McCaig LF, McLemore T. Plan and operation of the National Hospital Ambulatory Medical Survey. Series 1: programs and collection procedures. Vital Health Stat 1. 1994;34:1–78.

    PubMed  Google Scholar 

  17. 2009 National Ambulatory Medical Care Survey Micro-Data File Documentation. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/. Accessed 10 Oct 2015.

  18. 2010 National Ambulatory Medical Care Survey Micro-Data File Documentation. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/. Accessed 10 Oct 2015.

  19. 2009 National Hospital Ambulatory Medical Care Survey Micro-Data File Documentation. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/. Accessed 10 Oct 2015.

  20. 2010 National Hospital Ambulatory Medical Care Survey Micro-Data File Documentation. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/. Accessed 10 Oct 2015.

  21. Darkow T, Fontes CL, Williamson TE. Costs associated with the management of overactive bladder and related comorbidities. Pharmacotherapy. 2005;25(4):511–9.

    Article  PubMed  Google Scholar 

  22. Onukwugha E, Zuckerman IH, McNally D, Coyne KS, Vats V, Mullins CD. The total economic burden of overactive bladder in the United States: a disease-specific approach. Am J Manag Care. 2009;15(4 Suppl):S90–7.

    PubMed  Google Scholar 

  23. Goldman HB, Anger JT, Esinduy CB, Zou KH, Russell D, Luo X, et al. Real-world patterns of care for the overactive bladder syndrome in the United States. Urology. 2016;87:64–9.

    Article  PubMed  Google Scholar 

  24. Zarowitz BJ, Allen C, O’Shea T, Tangalos EG, Berner T, Ouslander JG. Challenges in the pharmacological management of nursing home residents with overactive bladder or urinary incontinence. J Am Geriatr Soc. 2015;63(11):2298–307.

    Article  PubMed  Google Scholar 

  25. American Hospital Formulary Service®. AHFS Drug Information. Bethesda, MD: Authority of the Board of the American Society of Health-System Pharmacists; 2016.

  26. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973;51(1):95–124.

    Article  CAS  PubMed  Google Scholar 

  27. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  28. Moga DC, Carnahan RM, Lund BC, Pendergast JF, Wallace RB, Torner JC, et al. Risks and benefits of bladder antimuscarinics among elderly residents of Veterans Affairs Community Living Centers. J Am Med Dir Assoc. 2013;14(10):749–60.

    Article  PubMed  Google Scholar 

  29. Association of Reproductive Health Professionals. Diagnosis and management of overactive bladder: a quick reference guide for clinicians. Available at: http://www.arhp.org/publications-and-resources/quick-reference-guide-for-clinicians/OAB. Accessed 19 Jul 2016.

  30. Tubaro A. Defining overactive bladder: epidemiology and burden of disease. Urology. 2004;64(6 Suppl 1):2–6.

    Article  PubMed  Google Scholar 

  31. Erdem N, Chu FM. Management of overactive bladder and urge urinary incontinence in the elderly patient. Am J Med. 2006;119(3 Suppl 1):29–36.

    Article  PubMed  Google Scholar 

  32. Wagg AS, Cardozo L, Chapple C, et al. Overactive bladder syndrome in older people. BJU Int. 2007;99(3):502–9.

    Article  PubMed  Google Scholar 

  33. Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46(12):1481–6.

    Article  CAS  PubMed  Google Scholar 

  34. Nabi G, Cody JD, Ellis G, Hay-Smith J, Herbison GP. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Cochrane Database Syst Rev. 2006;18(4):CD003781.

  35. Kessler TM, Bachmann LM, Minder C, Löhrer D, Umbehr M, Schünemann HJ, et al. Adverse event assessment of antimuscarinics for treating overactive bladder: a network meta-analytic approach. PLoS One. 2011;6(2):e16718.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Chapple CR, Khullar V,Gabriel Z, Muston D, Bitoun CE, Weinstein D. The effects of antimuscarinic treatments in overactive bladder: an update of a systematic review and meta-analysis. Eur Urol.2008; 54(3): 543-62.

    Article  CAS  PubMed  Google Scholar 

  37. Diagnosis and treatment of overactive bladder in adults: AUA/SUFU guideline (2012); Amended (2014). Available at: https://www.auanet.org/common/pdf/education/clinical-guidance/Overactive-Bladder-PC.pdf. Accessed 2 Nov 2015.

  38. Wagg A, Verdejo C, Molander U. Review of cognitive impairment with antimuscarinic agents in elderly patients with overactive bladder. Int J Clin Pract. 2010;64(9):1279–86.

    Article  CAS  PubMed  Google Scholar 

  39. Andersson KE. Antimuscarinics for treatment of overactive bladder. Lancet Neurol. 2004;3(1):46–53.

    Article  CAS  PubMed  Google Scholar 

  40. Chapple CR. Muscarinic receptor antagonists in the treatment of overactive bladder. Urology 2000;55(Suppl 5A):33–46.

  41. US Food and Drug Administration. FDA-approved drug products. 19 December 2012. Available at: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/. Accessed 10 Oct 2015.

  42. Lipton RB, Kolodner K, Wesnes K. Assessment of cognitive function of the elderly population: effects of darifenacin. J Urol. 2005;173:493–8.

    Article  PubMed  Google Scholar 

  43. Wagg A, Wyndaele J-J, Sieber P. Efficacy and tolerability of solifenacin in elderly subjects with overactive bladder syndrome: a pooled analysis. Am J Geriatr Pharmacother. 2006;4:14–24.

    Article  CAS  PubMed  Google Scholar 

  44. Chapple CR, Drogendijk T, Wright M, Bolodeoku J. Responses to solifenacin in patients >65 years and £65 years with overactive bladder syndrome: post-hoc results from the randomised, double-blind STAR study. Urology. 2007;70(Suppl. 3A):232.

    Article  Google Scholar 

  45. Liu M, Wang J, Yang Y, An R, Wen J, Guan Z, et al. Overactive bladder symptom score to evaluate efficacy of solifenacin for the treatment of overactive bladder symptoms. Chin Med J (Engl). 2014;127(2):261–5.

    PubMed  Google Scholar 

  46. Chapple CR, Cardozo L, Nitti VW, Siddiqui E, Michel MC. Mirabegron in overactive bladder: a review of efficacy, safety, and tolerability. Neurourol Urodyn. 2014;33(1):17–30.

    Article  CAS  PubMed  Google Scholar 

  47. Rudolph JL, Salow MJ, Angelini MC, et al. The Anticholinergic Risk Scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168:508–13.

    Article  PubMed  Google Scholar 

  48. Carnahan RM, Lund BC, Perry PJ, et al. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46:1481–6.

    Article  CAS  PubMed  Google Scholar 

  49. Boustani M, Campbell N, Munger S, et al. Impact of anticholinergics on the aging brain: a review and practical appllication. Aging Health. 2008;4:311–20.

    Article  CAS  Google Scholar 

  50. Wagg A, Nitti VW, Kelleher C, Castro-Diaz D, Siddiqui E, Berner T. Oral pharmacotherapy for overactive bladder in older patients: mirabegron as a potential alternative to antimuscarinics. Curr Med Res Opin. 2016;32(4):621–38.

    Article  CAS  PubMed  Google Scholar 

  51. Kasjan GR. Mirabegron: a new drug for treatment of overactive bladder [in Russian]. Urologiia. 2015;4:121–4.

    PubMed  Google Scholar 

  52. Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly adults. J R Soc Med. 2000;93(9):457–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Cardwell K, Hughes CM, Ryan C. The association between anticholinergic medication burden and health related outcomes in the ‘oldest old’: a systematic review of the literature. Drugs Aging. 2015;32(10):835–48.

    Article  CAS  PubMed  Google Scholar 

  54. Isetts BJ, Brown LM, Schondelmeyer SW, Lenarz LA. Quality assessment of a collaborative approach for decreasing drugrelated morbidity and achieving therapeutic goals. Arch Intern Med. 2003;163:1813–20.

    Article  PubMed  Google Scholar 

  55. Medicare Payment Advisory Commission. Report to the congress: medicare coverage of nonphysician practitioners. Washington, D.C: Medicare Payment Advisory Commission; 2002. p. 21–6.

    Google Scholar 

  56. Isetts BJ, Schondelmeyer SW, Artz MB, Lenarz LA, Heaton AH, Wadd WB, et al. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. J Am Pharm Assoc (2003). 2008;48(2):203–11.

    Article  Google Scholar 

  57. McLarin PE, Peterson GM, Curtain CM, Nishtala PS, Hannan PJ, Castelino RL. Impact of residential medication management reviews on anticholinergic burden in aged care residents. Curr Med Res Opin. 2016;32(1):123–31.

    Article  CAS  PubMed  Google Scholar 

  58. West T, Pruchnicki MC, Porter K, Emptage R. Evaluation of anticholinergic burden of medications in older adults. J Am Pharm Assoc (2003). 2013;53(5):496–504.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, 1441 Moursund Street, Houston, TX, 77030, USA

    Nandita Kachru, Sneha Sura, Satabdi Chatterjee & Rajender R. Aparasu

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  1. Nandita Kachru
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Correspondence to Rajender R. Aparasu.

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Nandita Kachru, Sneha Sura, Satabdi Chatterjee and Rajender R. Aparasu disclose no conflicts of interest.

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The authors have no relevant financial interests to declare for this study.

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Kachru, N., Sura, S., Chatterjee, S. et al. Antimuscarinic Medication Use in Elderly Patients with Overactive Bladder. Drugs Aging 33, 755–763 (2016). https://doi.org/10.1007/s40266-016-0399-5

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