Discontinuation of treatment using anticholinergic medications in patients with urinary incontinence.

Abstract

OBJECTIVE:

To evaluate the discontinuation rates of anticholinergics prescribed in patients with urinary incontinence (UI).

METHODS:

Data from a Disease Analyzer database including 988 general, 95 urologist, and 203 gynecologic practices were examined. Twenty six thousand eight hundred thirty-four patients were identified as having received a first-time anticholinergic prescription for UI, namely darifenacin, fesoterodine, oxybutynin, propiverine, solifenacin, tolterodine, or trospium, between 2005 and 2012. Covariates studied included demographic data, concomitant diagnoses, and potential drug-induced side effects. The cumulative discontinuation rate of initial treatment was estimated using a Kaplan-Meier analysis. A Cox proportional hazard regression model was used to estimate the relationship between discontinuation and the demographic and clinical variables for up to 36 months.

RESULTS:

An increasing discontinuation rate was observed in years 1, 2, and 3 (74.8%, 77.6%, 87%). Within 3 years, discontinuation rates were higher for men than for women (87.9%, 86.5%; P=.056; hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.11-1.18; P<.001), for patients treated in gynecologic practices and general practices than those treated in urologist practices (HR 1.60; 95% CI 1.52-1.67, P<.001 and HR 1.24, 95% CI 1.20-1.29, P<.001, respectively) and for younger patients than those older than 80 year old (60 years or younger, HR 1.27, 95% CI 1.22-1.33; 61-70 years, HR 1.16, 95% CI 1.11-1.21; 71-80 years, HR 1.14, 95% CI 1.09-1.18, P<.001). Those using propiverine or solifenacin were less likely to discontinue treatment than those using oxybutynin (HR 0.94, 95% CI 0.88-0.99, P=.024 and HR 0.93, 95% CI 0.87-0.98, P=.004, respectively).

CONCLUSION:

Patients with UI demonstrate high discontinuation rates for anticholinergics with only slight variations between the various drugs in this category.

LEVEL OF EVIDENCE:

: III.

• Authors: Matthias Kalder, Konstantinos Pantazis, Konstantinos Dinas, Ute-Susann Albert, Christina Heilmaier, Karel Kostev
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 124 Issue 4 Pg. 794-800 (Oct 2014) ISSN: 1873-233X [Electronic] United States
• PMID: 25198276 (Publication Type: Journal Article)

Chemical References

• Cholinergic Antagonists

Topics

• Aged
• Cholinergic Antagonists (adverse effects, therapeutic use)
• Cohort Studies
• Databases, Factual
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Urinary Bladder, Overactive (complications, drug therapy)
• Urinary Incontinence (drug therapy, etiology, physiopathology)
• Urodynamics
• Withholding Treatment