Risk of Mortality Associated with Non-selective Antimuscarinic medications in Older Adults with Dementia: a Retrospective Study

Background Selective antimuscarinics may offer a favorable safety profile over non-selective antimuscarinics for the management of overactive bladder (OAB) in patients with dementia. Objective To test the hypothesis that non-selective antimuscarinics are associated with increased risk of mortality c...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2020-07, Vol.35 (7), p.2084-2093
Main Authors: Kachru, Nandita, Holmes, Holly M., Johnson, Michael L., Chen, Hua, Aparasu, Rajender R.
Format: Article
Language:English
Subjects:
Adults
Aged
Bladder
Confidence intervals
Dementia
Dementia disorders
Government programs
Humans
Internal Medicine
Medicare
Medicine
Medicine & Public Health
Mortality
Muscarinic Antagonists - adverse effects
Older people
Original Research
Retrospective Studies
Risk
Safety
Sensitivity analysis
United States - epidemiology
Urinary Bladder, Overactive - drug therapy
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Summary:Background Selective antimuscarinics may offer a favorable safety profile over non-selective antimuscarinics for the management of overactive bladder (OAB) in patients with dementia. Objective To test the hypothesis that non-selective antimuscarinics are associated with increased risk of mortality compared to selective antimuscarinics in older adults with dementia and OAB. Design Propensity score-matched retrospective new-user cohort design among Medicare beneficiaries in community settings. Patients Older adults with dementia and OAB with incident antimuscarinic use. Main Measures The primary exposure was antimuscarinic medications classified as non-selective (oxybutynin, tolterodine, trospium, fesoterodine) and selective (solifenacin, darifenacin) agents. All-cause mortality within 180 days of incident antimuscarinic use formed the outcome measure. New users of non-selective and selective antimuscarinics were matched on propensity scores using the Greedy 5 → 1 matching technique. Cox proportional-hazards model stratified on matched pairs was used to evaluate the risk of mortality associated with the use of non-selective versus selective antimuscarinics in the sample. Key Results The study identified 16,955 (77.6%) non-selective antimuscarinic users and 4893 (22.4%) selective antimuscarinic users. Propensity score matching yielded 4862 patients in each group. The unadjusted mortality rate at 180 days was 2.6% (126) for non-selective and 1.6% (78) for selective antimuscarinic users in the matched cohort ( p value
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-020-05634-3