Yearly Trends of Overactive Bladder Medication Usage

Abstract

Introduction: Anticholinergics are associated with cognitive side effects and dementia. Agents such as trospium, fesoterodine and darifenacin have been shown to be less likely to cross the blood-brain barrier. Furthermore, in 2012, mirabegron was approved by the U.S. Food and Drug Administration as the first beta-3 adrenoreceptor agonist to treat overactive bladder (OAB). This study aims to examine prescribing patterns of OAB medications in the United States over time. Methods:The 2013e2017 Medicare Part D Public Use File was used to identify prescribers of OAB medications including oxybutynin, tolterodine, trospium, darifenacin, solifenacin, fesoterodine and mirabegron. The number of claims and total annual expenditure for each medication for all prescribers, nonurologists and urologists were analyzed from 2013 to 2017.Results: Oxybutynin was consistently the most prescribed OAB medication each year, comprising 53.9% of all OAB medication prescriptions in 2017. From 2013 to 2017, mirabegron claims increased from 140,401 to 1,617,439, making it the second most prescribed OAB medication. Solifenacin usage decreased each year. Trospium, darifenacin and fesoterodine were the least prescribed agents each year. These trends were similar for those !65 years old. Total annual expenditure for mirabegron increased yearly, and it had the highest total expenditure of OAB medications, with $658.6 million in 2017.Conclusions: Oxybutynin was consistently the most prescribed OAB medication every year. Mirabegron utilization steadily increased each year. Anticholinergic medications associated with fewer cognitive adverse effects, such as trospium, darifenacin and fesoterodine, were among the least prescribed.

Adverse Events for Overactive Bladder Medications From a Public Federal Database

“…According to Medicare Part D national data set, oxybutynin and mirabegron were the most commonly prescribed OAB medications from 2014 to 2018. This is consistent with our findings because most case reports were from oxybutynin (27%) and mirabegron (35%) 7–9 . As expected, oxybutynin had the least proportion of NP ADEs given the majority of the administration is transdermal.…”

“…This is consistent with our findings because most case reports were from oxybutynin (27%) and mirabegron (35%). [7][8][9] As expected, oxybutynin had the least proportion of NP ADEs given the majority of the administration is transdermal. However, within NP subcategories, transdermal oxybutynin was associated with an increased risk of affect/mood disorder, agitation, and balance/movement disorder compared with all other OAB medications.…”

“…Oxybutynin, solifenacin, and mirabegron made up most of the database because they are prescribed more often. Syan et al 17 looked a prescription drug insurance database from 2003 to 2016 and found an uptrend in mirabegron prescriptions and reciprocal downtrend of antimuscarinic prescriptions 9 . Because FAERS data does not provide causality, the reason for more frequent reporting of mirabegron is not obvious.…”

“…Syan et al 17 looked a prescription drug insurance database from 2003 to 2016 and found an uptrend in mirabegron prescriptions and reciprocal downtrend of antimuscarinic prescriptions. 9 Because FAERS data does not provide causality, the reason for more frequent reporting of mirabegron is not obvious. It could be that mirabegron is prescribed more often because of better patient tolerability; consequently, ADEs are more likely to be reported.…”

Clinical preferences and treatment attitudes among urologists, gynecologists, and geriatricians: An independent online questionnaire survey for comparison of treatment choices in the management of overactive bladder

“…They also showed that antimuscarinics (trospium, darifenacin, and fesoterodine), which produce lower cognitive side effects, were preferred for later stages of treatment. 34 In our study, among the antimuscarinic preferences in elderly OAB patients, trospium (URO 27.5%, GER 42.9%) and solifenacin (URO 27%, GER 20.6%) were the preferred drugs by URO and GER, while solifenacin (22%), oxybutynin (15.7%), and tolterodine (15.3%) were preferred by OB/GYNs. The quaternary molecular structure of trospium and noncrossing capability of blood-brain barrier of trospium might be the reason for choosing for this molecule.…”