MP33-20 ANTICHOLINERGIC CYCLING AND TREATMENT OUTCOMES IN OVERACTIVE BLADDER PATIENTS WITH URINARY INCONTINENCE (2014)

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy I1 Apr 2014MP33-20 ANTICHOLINERGIC CYCLING AND TREATMENT OUTCOMES IN OVERACTIVE BLADDER PATIENTS WITH URINARY INCONTINENCE Michael Chancellor, Riya Pulicharam, I-Ning Cheng, Karen Campbell, Catherine Corbell, Manher Joshi, and Denise Globe Michael ChancellorMichael Chancellor More articles by this author , Riya PulicharamRiya Pulicharam More articles by this author , I-Ning ChengI-Ning Cheng More articles by this author , Karen CampbellKaren Campbell More articles by this author , Catherine CorbellCatherine Corbell More articles by this author , Manher JoshiManher Joshi More articles by this author , and Denise GlobeDenise Globe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.971AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Overactive bladder (OAB) is a prevalent medical condition affecting 16.5% of US adults. Anticholinergic (Ach) therapies are recommended as first-line pharmacotherapy in OAB (following behavioral therapy). A high failure rate to the first prescribed Ach is well-documented in the literature. However, there is a paucity of studies on follow-on Ach use and treatment outcomes in patients who fail their first prescribed Ach. In this study, we analyzed Ach cycling in a cohort of OAB patients with urinary incontinence (UI). METHODS We conducted a retrospective claim analysis linked to a patient survey administered to OAB patients, who were members of a California-based managed care organization. Study participants had ≥1 UI episodes/day and initiated Ach therapy between January 2008 and May 2012. Claims data were used to track health resource utilization through May 2013. A one-time patient questionnaire was administered to collect information on urinary symptoms, bother etc. RESULTS A total of 655 patients were enrolled into the study (79.2% women; mean age 72.8 years, standard deviation (SD): 12.5). Patients were followed up for an average of 3.4 years based on their claims data. During the follow-up period, patients cycled through 1 to 6 unique Achs; 65% of the study population used only 1 Ach while 35% used ≥2 Achs (Table). Most patients (71.3%) discontinued Achs by the end of follow-up; discontinuation rates remained high with ≥2 Achs. The mean UI episodes/day observed ranged from 3.3-3.9 with use of 1 through 6 Achs. Over 80% of patients continued to be bothered by their bladder symptoms, whether or not they remained on Achs. CONCLUSIONS In this population of OAB patients with UI, the mean UI episodes/day and the percent of patients still bothered by bladder symptoms remained relatively constant, regardless of the number of Achs attempted (1 to 6). In addition, discontinuation rates were high regardless of number of Achs attempted. This analysis suggests that continual Ach cycling is not an optimal treatment approach following failure of the first prescribed Ach. Anticholinergic cycling in 655 overactive bladder patients with urinary incontinence No. of anticholinergics (Ach) prescribed All patients (n= 655 ) 1 Ach (n=426, 65%) 2+ Ach (n=229, 35%) 3 Ach (n=39) 4+ Ach* (n=11) 1 Ach (n=426 ) 2 Ach (n=176) Disposition, n (%) Continued Ach use** 188 (28.7) 94 (22.1) 71 (40.3) 16 (41.0) 7 (50.0%) Discontinued Ach use 467 (71.3) 332 (77.9) 105 (59.7) 23 (59.0) 7 (50.0%) Mean number of urinary incontinence episodes/day (SD) 3.6 (3.4) 3.7 (3.5) 3.4 (3.4) 3.3 (2.7) 3.9 (2.3) % patients still bothered by bladder problems Continued Ach use** 87.7% 86.4% 91.3% 82.4% 100.0% Discontinued Ach use 88.8% 88.2% 89.3% 100.0% 100.0% *4+ Ach group includes patients cycled through 4-6 Achs **Continued Ach use includes intermittent anticholinergic use © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e345-e346 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael Chancellor More articles by this author Riya Pulicharam More articles by this author I-Ning Cheng More articles by this author Karen Campbell More articles by this author Catherine Corbell More articles by this author Manher Joshi More articles by this author Denise Globe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...