Long-Term Patterns of Use and Treatment Failure With Anticholinergic Agents for Overactive Bladder

• Published in: Clinical therapeutics 2013-11, Vol.35 (11), p.1744-1751
• Main Authors: Chancellor, Michael B., MD, Migliaccio-Walle, Kristen, BS, Bramley, Thomas J., PhD, Chaudhari, Sham L., MS, Corbell, Catherine, PhD, Globe, Denise, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; anticholinergic medication; Biological and medical sciences; Bladder; Cholinergic Antagonists - therapeutic use; Codes; Compliance; Drug Substitution - statistics & numerical data; Drug therapy; Failure; Female; Humans; Internal Medicine; Male; Medicaid; Medical Education; Medical sciences; Medicare; Mens health; Middle Aged; Nephrology. Urinary tract diseases; Older people; overactive bladder; Patient Compliance - statistics & numerical data; Patients; persistence; Pharmacology. Drug treatments; Pharmacy; Prescription drugs; resource utilization; Retrospective Studies; Studies; Treatment Failure; Urinary Bladder, Overactive - drug therapy; Urinary incontinence; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Womens health; Young Adult
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2013.08.017

Abstract Background Overactive bladder (OAB) involves a complex set of symptoms with a lifetime prevalence of any symptom in ~30% of women and 20% of men. Anticholinergic agents are associated with poor medication persistence in OAB treatment. Objective This study evaluated the long-term patterns of use and treatment failure in patients prescribed anticholinergic agents for OAB. Methods This was a nonexperimental, retrospective cohort study. Medical, pharmacy, and eligibility data from the IMS LifeLink Health Plans Claims Database were used. Men and women aged ≥18 years were eligible for inclusion with an International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis of OAB in any field during the patient study period from January 2005 to June 2010. First documentation of a prescription filled between July 2005 and June 2008 for an anticholinergic agent was defined as the index prescription. Other inclusion criteria were: ≥1 pharmacy claim for an anticholinergic drug between July 2005 and June 2008; continuous enrollment 6 months before the index date, during which no anticholinergic drugs were filled; and 24 months of follow-up from the index prescription. Study outcomes were treatment failure, discontinuation, switch, reinitiation, and adherence. Treatment failure was defined as having a treatment discontinuation (ie, treatment gap of ≥45 days) or switching anticholinergic therapy. Results The analytic cohort comprised 103,250 patients with a mean age of 58.7 years. A majority were female (73%) and privately insured (75%). The vast majority of patients (91.7%) failed to meet their treatment goals with their index anticholinergic agent over the 24-month follow-up period. Of these, 5.8% switched, 51.3% permanently discontinued all anticholinergic agents, and 34.6% reinitiated treatment sometime after 45 days. The mean (SD) time to treatment failure was 159 (216.0) days, with a mean of 1.3 (0.5) unique anticholinergic agents per patient. Forty-eight percent of patients demonstrated appropriate adherence as determined by a medication possession ratio ≥80%. Conclusions This study provides real-world data on treatment patterns over 2 years in a large cohort of patients diagnosed with OAB. Despite the potential for better adherence with some anticholinergic agents, these analyses suggest that such benefits have not yet been realized, and many patients end up without effective pharmacotherapy. Thus, there is a need for new therapies a