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

ΤίτλοςDiscontinuation of treatment using anticholinergic medications in patients with urinary incontinence.
Publication TypeJournal Article
Year of Publication2014
AuthorsKalder, M., Pantazis K., Dinas K., Albert U-S., Heilmaier C., & Kostev K.
JournalObstet Gynecol
Volume124
Issue4
Pagination794-800
Date Published2014 Oct
ISSN1873-233X
Λέξεις κλειδιάAged, Cholinergic Antagonists, 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, Urinary Incontinence, Urodynamics, Withholding Treatment
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.

DOI10.1097/AOG.0000000000000468
Alternate JournalObstet Gynecol
PubMed ID25198276

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