Who Progresses to Third-Line Therapies for Overactive Bladder? Trends From the AQUA Registry

Abstract

Study Need and Importance: Overactive bladder (OAB) patients who do not reach treatment goals after second-line OAB treatments should be offered third-line therapies (percutaneous tibial nerve stimulation, sacral neuromodulation, bladder onabotulinumtoxinA). However, many patients who may be appropriate for third-line therapies may not ultimately receive them. Using the AUA Quality (AQUA) Registry, we evaluated factors that impact progression from second-to third-line OAB therapy, median time for progression to third-line therapy, and third-line therapy utilization across patient subgroups. What We Found: Only 2.9% of OAB patients progressed to third-line therapies over the 7-year study period. Women, White race, age 65 to 79, prior dual anticholinergic and b3 agonist therapy, government insurance, metropolitan setting, and single specialty practice were associated with the greatest odds of treatment with third-line therapy. Time to progression from second-to third-line therapies was > 1 year. Patients < 50 years and women progressed fastest through the OAB pathway. Black and Asian race, male gender, and rural setting all had lower odds of progressing to third-line therapy. Bladder onabotulinumtoxinA was the most common initial third-line therapy overall (40%), followed by sacral neuromodulation (32%) and percutaneous tibial nerve stimulation (28%). The Figure demonstrates the choice of initial third-line therapy across subgroups. Limitations: The AQUA Registry does not provide information on OAB severity or capture any patient-reported UROLOGY PRACTICE Ò Ó 2024 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC.