Rethinking Second-Line Therapy for Overactive Bladder to Improve Patient Access to Treatment Options

Abstract

Idiopathic overactive bladder (OAB) is a chronic condition that negatively affects quality of life, and oral medications are an important component of the OAB treatment algorithm. Recent literature has shown that anticholinergics, the most commonly prescribed oral medication for the treatment of OAB, are associated with cognitive side effects including dementia. β3-adrenoceptor agonists, the only alternative oral treatment for OAB, are similar in efficacy to anticholinergics with a more favorable side effect profile without the same cognitive effects. However, there are marked cost variations and barriers to access for OAB medications, resulting in expensive copays and medication trial requirements that ultimately limit access to β3-adrenoceptor agonists and more advanced procedural therapies. This contributes to and perpetuates health care inequality by burdening the patients with the least resources with a greater risk of dementia. When prescribing these medications, health care professionals are caught in a delicate balancing act between cost and patient safety. Through multilevel collaboration, we can help disrupt health care inequalities and provide better care for patients with OAB.

Urinary dysfunction in patients with vascular cognitive impairment

“…If capable of improving the quality of a patient’s life, clinicians can choose a low-dose anticholinergic drug such as trospium, darifenacin, or fesoterodine with good physicochemical and clinical cognitive safety evidence and use it according to the patient’s condition and willingness ( Welk et al, 2021 ). Meanwhile, β 3 -adrenoceptor agonists mirabegron and vibegron are effective in treating OAB and have not been associated with anticholinergic-related cognitive impairment ( Escobar et al, 2021 ). Nevertheless, mirabegron may affect the cardiovascular system, inducing palpitations, facilitating or worsening hypertension, and rarely, inducing atrial fibrillation ( Chapple et al, 2014 ; Escobar et al, 2021 ).…”

Evidence-Informed, Interdisciplinary, Multidimensional Action Plan to Advance Overactive Bladder Research and Treatment Initiatives: Directives From State-of-the-Science Conference on Overactive Bladder and Cognitive Impairment

“…The multifactorial nature of OAB creates challenges for health care professionals, patients, and their care partners in many settings across the continuum of OAB health care delivery. Therefore, the approach to improve OAB care requires multiple stakeholders, including patients, family, care partners, health care professionals, academic and private health care institutions, industry, private and public payers, public and private funding agencies, and policymakers 30 . The objective of this article is to outline an evidence-informed, interdisciplinary, multidimensional, comprehensive action plan for AUGS and the PFD Research Foundation to improve the care of women with OAB while minimizing treatment-related adverse events (AEs), including cognitive impairment.…”

Injectable, Adhesive, and Self-Healing Composite Hydrogels Loaded With Oxybutynin Hydrochloride for the Treatment of Overactive Bladder in Rats

“…In recent years, anticholinergic drugs have been the main treatment for OAB ( Song et al, 2021 ) and oxybutynin hydrochloride is a typical representative. Anticholinergic drugs can block postganglionic muscarinic receptors, reduce bladder contractility, reduce bladder internal pressure, and increase the threshold of urination capacity ( Cakir et al, 2019 ; Escobar et al, 2021 ). However, in clinical practice, only a few patients insist on using anticholinergic drugs for more than 6 months at present.…”