Mirabegron and antimuscarinic use in frail overactive bladder patients in the United States Medicare population

Johnson, Theodore M.; Walker, David; Lockefeer, Amy; Jiang, Baoguo; Nimke, David; Lozano‐Ortega, Greta; Kimura, Tomomi

doi:10.1002/nau.25040

Cited by 6 publications

(1 citation statement)

References 37 publications

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“…Johnson et al evaluated OAB medication usage in 2,527 patients in the United States who were prescribed either mirabegron (21%) or an antimuscarinic drug (79%) [ 29 ]. Among them, 1,032 used antimuscarinic drugs (median age: 81 years, 62% female) and 516 used mirabegron (median age: 82 years, 64% female).…”

Section: Discussionmentioning

confidence: 99%

Ninjin’yoeito Improves Genitourinary Symptoms in Patients With Frailty

Okui¹,

Okui²

2023

Cureus

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Introduction In geriatric medicine, there is currently significant attention on frailty, a condition commonly associated with aging and characterized by muscle weakness and other age-related changes. Within the fields of urology and gynecology, conditions such as overactive bladder (OAB) and genitourinary syndrome of menopause (GSM) have been identified as crucial concerns due to their negative impact on the quality of life of elderly individuals. In this study, we investigated the potential of Ninjin'yoeito (NYT), a traditional Chinese herbal medicine, as a viable treatment option for frailty. Additionally, we hypothesized that NYT may also contribute to the improvement of symptoms associated with OAB and GSM, and potentially help in reducing the dosage of OAB medications. Methods In this retrospective cohort study conducted from November 2016 to November 2022, we created a website describing the relationship between frailty and genitourinary symptoms in frail patients aged ≥ 65 years with GSM who underwent pelvic floor muscle training. The patients were divided into two propensity score-matched groups: NYT group (received NYT for one year) and no-NYT group (did not receive NYT), based on their wishes. The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale was used to assess frailty status. Urinary symptoms were evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Overactive Bladder Symptom Score (OABSS). Genital symptoms were investigated using the vaginal health index score and vulvodynia swab test. The value of each score was obtained before (T0) and 12 months after (T12) treatment, and the difference (Δ T0/T12 ) was calculated. Results During the study period, 985 outpatients visited our clinic, of whom 725 were considered frail/pre-frail; 402 women with frailty/pre-frailty (mean age 77.5 ± 6.49 years) were included, with a median follow-up of 14.5 months. The NYT and no-NYT groups had 220 and 182 patients, respectively. After propensity score matching, each group had 159 patients. Δ T0/T12 FRAIL scale score was significantly higher in the NYT group (0.13 ± 0.37) than in the no-NYT (0.01 ± 0.10) group (p=0.001.) However, urinary symptoms improved in the NYT group more than in the no-NYT in terms of the following parameters: Δ T0/T12 OABSS (NYT: 0.89 ± 1.65; no-NYTl: 0.36 ± 1.14, p=0.001) and Δ T0/T12 ICIQ-SF score (NYT: 1.51 ± 1.75; no-NYT: 0.42 ± 1.18, p<0.001). Genital symptoms were better in the NYT group in terms of ΔT0/T12 VHIS (NYT: 0.58 ±1.08; no-NYT: 0.21 ±0.65, p<0.001). The vulvodynia swab test showed improvements in left para-hymen evoked pain in both groups. In the NYT group, 5% of the patients underwent antimuscarinic drug dose reduction for overactive bladder treatment. NYT use was not associated with significant side effects, and only 0.6% of pati...

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Section: Discussionmentioning

confidence: 99%

Ninjin’yoeito Improves Genitourinary Symptoms in Patients With Frailty

Okui¹,

Okui²

2023

Cureus

View full text Add to dashboard Cite

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Mirabegron and antimuscarinic use in frail overactive bladder patients in the United States Medicare population

Johnson

Walker

Lockefeer

et al. 2022

Neurourology and Urodynamics

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Introduction Overactive bladder (OAB) and frailty are independently associated with patient burden. However, economic burden and treatment‐taking behavior have not been well characterized among frail patients with OAB, which, given the varying safety and tolerability profiles of available treatments, is crucial. Objectives To assess costs, health care resource utilization, treatment‐taking behavior (persistence and adherence) to OAB medication in older, frail OAB patients. Methods This was a retrospective cohort study using international business machines MarketScan Medicare Supplemental claims data. Eligible frail patients (per Claims‐based Frailty Index score) initiating mirabegron were 1:2 propensity score matched (based on age, sex, and other characteristics) with those initiating antimuscarinics and were followed up to 1 year. All‐cause, per‐person, per‐month costs, health care encounters, persistence (median days to discontinuation assessed using Kaplan−Meier methods) and adherence (≥80% of proportion of days covered at Day 365) were compared. Results From 2527 patients with incident mirabegron (21%) or antimuscarinic (79%) dispensations, 516 incident mirabegron users (median age: 82 years, 64% female) were matched to 1032 incident antimuscarinic users (median age: 81 years, 62% female). Median cost was higher in mirabegron group ($1581 vs. $1197 per month); this was primarily driven by medication cost. There was no difference in medical encounters. Adherence (39.1% vs. 33.8%) and persistence (103 vs. 90 days) were higher in mirabegron users. Conclusions Among frail older adults with OAB, mirabegron use was associated with higher costs and potential improvements in treatment‐taking behaviors, particularly with respect to treatment adherence, versus those initiating antimuscarinics.

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