Incidence and risk factors of recurrence of overactive bladder symptoms after discontinuation of successful medical treatment

Abstract

PurposeTo identify incidence and risk factors of recurrence after discontinuation of successful antimuscarinic therapy in patients with overactive bladder (OAB).Materials and MethodsThis was a prospective, multicenter trial. Patients who had antimuscarinic agents for more than 12 weeks and showed successful response were enrolled. Successful response was defined as answering 'benefit' for patient perception of treatment benefit and answer lesser than 3 points in patient's perception of bladder condition (PPBC). The enrolled patients discontinued the antimuscarinics, and we evaluated their recurrence with PPBC and OAB symptom score (OABSS) at 1, 3, 6, and 12 months. Primary purpose was to identify the recurrence rate and secondary purpose was to reveal risk factors.ResultsFour hundred forty-one patients enrolled and 371 patients completed 6-month follow-up. The enrolled patients showed 1.6 points in PPBC, 2.9 points in OABSS and 1.4 points in IPSS (quality of life) which represented successful response after using antimuscarinics. The cumulative rates of recurrence were 25.6%, 42.3%, and 52.2% at 1, 3, 6 months, respectively. Among 177 patients who did not show recurrence at 6 months, 41 patients were followed up and 4 patients of the 41 patients (9.7%) showed recurrence at 12 months. On univariate and multivariate analyses of recurrence, OAB wet was the risk factor for recurrence after 6 months of discontinuation.ConclusionsDiscontinuation of antimuscarinic therapy after successful treatment resulted in high recurrence rate with time and OAB wet was the independent risk factor for recurrence.

Higher urge severity score predicts resumption of overactive bladder (OAB) medication following discontinuation of mirabegron treatment in patients with OAB

“…This result parallels similar findings of other studies conducted on OAB patients treated with antimuscarinics. For example, Kim et al found that OAB wet and female sex are independent risk factors after discontinuation of successful antimuscarinic treatment, Choo et al found that patients in the retreatment group had higher baseline urgency scores and were older than those seeking no further treatment, and a report from the UK found that patients who expressed beneficial effects of fesoterodine treatment showed a greater improvement after treatment and a greater deterioration after drug cessation than patients who did not respond positively . The present study has shown that patients resuming mirabegron had significantly more severe OAB symptoms at the time of mirabegron resumption than at the time of drug cessation.…”

“…Limited studies have examined the natural course of patients following the discontinuation of antimuscarinics once their symptoms have improved. Kim et al reported that 74.6%, 57.7%, and 47.8% patients had no recurrent OAB symptoms at 1, 3, and 6 months, respectively, after successful treatment (≥12 weeks) with antimuscarinics. Choo et al reported that approximately one‐third of OAB patients sought retreatment 1 month after discontinuation of antimuscarinic therapy following successful treatment with propiverine.…”

“…Limited studies have shown that although OAB patients may discontinue using antimuscarinic agents after an adequate period of treatment, patients who are older age and with more severe urgency urinary incontinence (UUI) tend to resume medical treatment after a certain period of time . However, to the best of our knowledge, no studies have indicated how long a patient should maintain treatment with β 3 ‐adrenoceptor agonists for OAB, which factors are favorable for discontinuation of medication, and how many OAB patients suffer symptom relapse after discontinuing mirabegron.…”

The Pharmacotherapy Time-to-Effect of Overactive Bladder Medications and Treatment Duration

“…Kim et al analyzed 371 participants that took antimuscarinic medication for a minimum of 12 weeks and had their symptoms subsided (35). The study stopped the treatment and viewed for symptom relapse for 1, 3, 6, and 12 months.…”

How long do we have to treat overactive bladder syndrome? A questionnaire survey of Canadian urologists and gynecologists

“…A recently-published study enrolled 371 OAB patients who took antimuscarinic agents for more than 12 weeks and responded favorably. 25 They then discontinued antimuscarinics and were evaluated for recurrence of bothering symptoms at baseline, 1, 3 and 6 months, with a limited number of patients followed up for 12 months. Cumulative recurrence rates at 1, 3 and 6 months were concurrent with earlier studies and were 25.6%, 42.3% and 52.2%, respectively.…”