Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk

Menhaji, Kimia; Cardenas-Trowers, Olivia; Chang, Olivia H.; Hall, Evelyn F.; Ringel, Nancy; Falk, Kerac N

doi:10.1007/s00192-021-04736-8

Cited by 16 publications

(17 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This has been demonstrated in a survey among urogynecology providers, as 61.8% reported that a trial of anticholinergics was required by insurance payers prior to authorizing mirabegron for a majority of their patients, and 74.6% described the prior-authorization process as difficult. 26 Another interesting finding of our study is that mirabegron had the highest total expenditure out of any OAB medication by 2017. This raises the question of whether increased prescribing of mirabegron may increase health care costs for OAB.…”

Section: Discussionmentioning

confidence: 56%

Yearly Trends of Overactive Bladder Medication Usage

et al. 2021

View full text Add to dashboard Cite

Introduction: Anticholinergics are associated with cognitive side effects and dementia. Agents such as trospium, fesoterodine and darifenacin have been shown to be less likely to cross the blood-brain barrier. Furthermore, in 2012, mirabegron was approved by the U.S. Food and Drug Administration as the first beta-3 adrenoreceptor agonist to treat overactive bladder (OAB). This study aims to examine prescribing patterns of OAB medications in the United States over time. Methods:The 2013e2017 Medicare Part D Public Use File was used to identify prescribers of OAB medications including oxybutynin, tolterodine, trospium, darifenacin, solifenacin, fesoterodine and mirabegron. The number of claims and total annual expenditure for each medication for all prescribers, nonurologists and urologists were analyzed from 2013 to 2017.Results: Oxybutynin was consistently the most prescribed OAB medication each year, comprising 53.9% of all OAB medication prescriptions in 2017. From 2013 to 2017, mirabegron claims increased from 140,401 to 1,617,439, making it the second most prescribed OAB medication. Solifenacin usage decreased each year. Trospium, darifenacin and fesoterodine were the least prescribed agents each year. These trends were similar for those !65 years old. Total annual expenditure for mirabegron increased yearly, and it had the highest total expenditure of OAB medications, with $658.6 million in 2017.Conclusions: Oxybutynin was consistently the most prescribed OAB medication every year. Mirabegron utilization steadily increased each year. Anticholinergic medications associated with fewer cognitive adverse effects, such as trospium, darifenacin and fesoterodine, were among the least prescribed.

show abstract

Section: Discussionmentioning

confidence: 56%

Yearly Trends of Overactive Bladder Medication Usage

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In patients with uncontrolled hypertension attacks, of whom mirabegron cannot be used, 51.5% of participants preferred "nervous system-sparing" antimuscarinics. 14 Despite the current literature, results from this study indicated that antimuscarinics are highly preferred for the initial and combination treatment of OAB. Several explanations for this preference may be long-term availability of antimuscarinics in the market, cost-efficacy, and the prescribing habits of physicians.…”

Section: Discussionmentioning

confidence: 61%

“…It has also been shown that after beta-3 agonists were available in the market, a shift in prescription habits of the physicians has occurred. 13,14 In clinical practice, patients with OAB also present to and are treated by urologists (URO), obstetricians and gynecologists (OB/GYN), and geriatricians (GER). Treatment choices can vary due to several factors and prescription differences may occur between specialties.…”

Section: Introductionmentioning

confidence: 99%

Clinical preferences and treatment attitudes among urologists, gynecologists, and geriatricians: An independent online questionnaire survey for comparison of treatment choices in the management of overactive bladder

Onur

Bayrak

Çoşkun

et al. 2022

Neurourology and Urodynamics

View full text Add to dashboard Cite

Objective Overactive bladder (OAB) is a common clinical problem with associated morbidities both in men and women. Although real‐life management strategies have been examined among urologists (URO), treatment choices may differ between different specialties. In the present study, an online survey was conducted to determine and compare the management strategies and clinical preferences of UROs, obstetricians/gynecologists (OB/GYN), and geriatricians (GER) in the treatment of OAB in their daily practices. Methods Between December 2020 and February 2021, an online questionnaire was sent to URO, OB/GYN, and GER specialists/residents. Current strategies and attitudes toward treatment of OAB in patients <65 years were compared between URO and OB/GYN, whereas the responses were compared between all three specialties in patients ≥65 years. Results A total of 733 specialists/physicians (433 URO, 236 OB/GYN, and 64 GER) completed the online survey. Patients with OAB were more likely to present to URO compared to OB/GYN and GER (p = 0.001). A combination of behavioral modification and pharmacotherapy (antimuscarinics and/or beta‐3 agonists) were chosen for the initial treatment of patients with OAB in both specialties with a significantly higher proportion by URO than by OB/GYN (51.9% vs. 38.1%; p = 0.001). Antimuscarinics were the most frequently prescribed medications by both the URO and OB/GYN specialties (81.8% vs. 78.4%; p = 0.27). Combination therapy with antimuscarinics was preferred more often by URO (91.5% vs. 77.1%; p = 0.001) when no or an inadequate response after initial treatment occurred. Multiple medication use, comorbidities, and risk of cognitive side effects affected medication preference by all specialists, especially by GER (p = 0.018). Conclusions Patients with OAB present to UROs, OB/GYN and GER more frequently compared to other specialities. Although antimuscarinics and beta‐3 adrenoceptor agonists are equally recommended as first‐line pharmacotherapy for OAB, antimuscarinics were preferred for most patients as the initial molecule by all specialties. Beta‐3 agonists are increasingly preferred for elderly patients.

show abstract

“…Notably, an online survey of 222 primarily (97%) US urology/gynaecology providers indicated that studies associating anticholinergics with the development of dementia have motivated a shift away from prescribing anticholinergics towards β 3 -adrenergic receptor agonists for patients with OAB. 43 …”

Section: Discussionmentioning

confidence: 99%

Long-term efficacy and safety of vibegron versus mirabegron and anticholinergics for overactive bladder: a systematic review and network meta-analysis

Kennelly¹,

Wielage²,

Shortino³

et al. 2020

DIC

View full text Add to dashboard Cite

Background Few randomized controlled trials evaluate the long-term efficacy and safety of pharmacotherapy for overactive bladder (OAB). This network meta- analysis compares the long-term (52-week) efficacy and safety of vibegron, mirabegron and anticholinergics for the treatment of OAB. Methods A systematic literature review and network meta-analysis were conducted following PRISMA guidelines using MEDLINE, Embase and Cochrane Central Register of Controlled Trials and terms related to OAB. Efficacy outcomes included change from baseline to week 48–52 in mean daily total urinary incontinence (UI) episodes, mean daily number of micturitions and volume voided/micturition. Efficacy outcomes were analysed using Bayesian models. Commonly reported adverse events (AEs) are described. Results Of 2098 hits retrieved, 5 publications and 1 study report describing 5 unique randomized controlled trials were included in the analyses. Mean (95% credible interval) change from baseline in total UI episodes for vibegron 75 mg (−2.2; −2.9 to −1.5) showed a significantly greater reduction than mirabegron 50 mg (−1.3; −1.9 to −0.8) and tolterodine 4 mg extended release (−1.6; −2.1 to −1.1). No significant differences were observed between vibegron and comparators for daily micturitions or volume voided/micturition. Within the manuscripts, the 4 most common AEs (range) for anticholinergics included dry mouth (5.2–90.0%), constipation (7.7–65.0%), blurred vision (3.8–35.0%) and hypertension (8.6–9.6%); the 4 most commonly reported AEs for β 3 -adrenergic agonists included hypertension (8.8–9.2%), urinary tract infection (5.9–6.6%), headache (5.5%) and nasopharyngitis (4.8–5.2%). Conclusion Vibegron was associated with significantly greater improvement in daily total UI episodes at 52 weeks than mirabegron and tolterodine. When reported, the most common AE for anticholinergics was dry mouth and for β 3 -adrenergic agonists was hypertension. Hypertension incidence was similar between drug classes.

show abstract

Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk

Cited by 16 publications

References 27 publications

Yearly Trends of Overactive Bladder Medication Usage

Yearly Trends of Overactive Bladder Medication Usage

Clinical preferences and treatment attitudes among urologists, gynecologists, and geriatricians: An independent online questionnaire survey for comparison of treatment choices in the management of overactive bladder

Long-term efficacy and safety of vibegron versus mirabegron and anticholinergics for overactive bladder: a systematic review and network meta-analysis

Contact Info

Product

Resources

About