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Limitations of anticholinergic cycling in patients with overactive bladder (OAB) with urinary incontinence (UI): results from the CONsequences of Treatment Refractory Overactive bLadder (CONTROL) study

  • Urology - Original Paper
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Abstract

Purpose

To describe treatment patterns and outcomes in wet-overactive bladder (OAB) patients treated with anticholinergics.

Methods

This study was a retrospective claims analysis linked to a one-time patient survey of members of a regional medical group located in California. Participants met the following criteria: received anticholinergic therapy between January 2008 and May 2012, based on pharmacy claims; had a diagnosis of OAB; and reported having ≥1 urinary incontinence (UI) episode per day at the time of the survey. Outcomes included the number of anticholinergics cycled through from treatment initiation until the end of follow-up (May 31, 2013); frequency of UI episodes; and patient requests for additional help for their OAB symptoms.

Results

A total of 620 patients were enrolled into the study. During the follow-up period, patients cycled through 1 to 6 unique anticholinergics; 65 % of the study population used only 1 anticholinergic, while 35 % used ≥2 anticholinergics. Patients reported experiencing an average of 3.5 UI episodes per day (3.6, 3.3, and 3.4 episodes for 1, 2, and ≥3 anticholinergics used, respectively), and over 80 % of patients requested additional help for their OAB symptoms, irrespective of how many anticholinergics were attempted.

Conclusion

UI symptom burden and adherence to therapy did not change as patients attempted more anticholinergic therapies. These results suggest that for patients who remain incontinent after attempting an anticholinergic, cycling on additional anticholinergics may not provide any additional benefit, resulting in sub-optimal care.

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Acknowledgments

This study was sponsored by Allergan plc, Dublin, Ireland. Writing and editorial assistance was provided to the authors by Lisa Bloudek, PharmD, MS, and Evelyn Sarnes, PharmD, MPH of Xcenda, LLC, Palm Harbor, FL, and funded by Allergan plc, Dublin, Ireland. All authors met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship.

Funding

This study was funded by Allergan plc, Dublin, Ireland.

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Authors and Affiliations

  1. Beaumont Health System, Beaumont Hospital, Royal Oak, MI, USA

    Michael B. Chancellor

  2. Allergan, Inc., Irvine, CA, USA

    Alon Yehoshua, Karen L. Campbell & Manher Joshi

  3. Medtronic, Inc., Minneapolis, MN, USA

    Catherine Waweru

  4. Novartis, Inc., East Hanover, NJ, USA

    Denise Globe

  5. Roche Molecular Systems, Inc., Pleasanton, CA, USA

    I-Ning Cheng

  6. HealthCare Partners, Torrance, CA, USA

    Riya Pulicharam

Authors
  1. Michael B. Chancellor
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  2. Alon Yehoshua
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  3. Catherine Waweru
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  4. Denise Globe
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  5. I-Ning Cheng
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  6. Karen L. Campbell
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  7. Manher Joshi
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  8. Riya Pulicharam
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Corresponding author

Correspondence to Michael B. Chancellor.

Ethics declarations

Conflict of interest

M.B.C. has received compensation for consultant and advisory board participation from Allergan plc. A.Y., D.G., C.W., K.L.C., and M.J. are currently employees of or were employees of Allergan when this study was conducted. I.C. and R.P. are currently or were employees of HealthCare Partners when this study was conducted.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

See Table 2.

Table 2 List of anticholinergics and generic product identifier (GPI) codes included
Full size table

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Chancellor, M.B., Yehoshua, A., Waweru, C. et al. Limitations of anticholinergic cycling in patients with overactive bladder (OAB) with urinary incontinence (UI): results from the CONsequences of Treatment Refractory Overactive bLadder (CONTROL) study. Int Urol Nephrol 48, 1029–1036 (2016). https://doi.org/10.1007/s11255-016-1277-0

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  • DOI: https://doi.org/10.1007/s11255-016-1277-0

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