The authors developed a prospective study evaluating women over the age of 65 who were starting treatment with fesoterodine for OAB. Women were eligible to participate if they responded “quite a bit” of urinary urgency on the OABQ-SF. All women received fesoterodine, though dosing varied between subjects. For outcome measures, the authors used validated measures of physical activity, physical function, balance, and neurocognitive function. Urinary symptoms were assessed with OABq-SF, UDI-6, and PGI-I scores. Subjects were assessed at baseline, 4 weeks, and 8 weeks.
The study included 74 women with a mean age of 76.5 years, and they had 75% follow-up at 8 weeks. There was a significant decrease in number of steps, energy expenditure and increase in sedentary behavior over the study period, but no change in self-reported physical activity. There was no significant difference in falls prior to and after starting the medication. Balance scores were not significantly changed. Urinary symptoms were statistically significantly improved with medication.
The authors conclude that treatment of older women with OAB with fesoterodine is effective for reducing urinary symptoms while maintaining safety in respect to physical activity, cognitive function, and fall risk. Interestingly, there was no increase in physical activity along with the improvement in urinary symptoms. Overall, the study lacks a control group and the follow-up time is short. In order to adequately assess the risk of cognitive decline and with fesoterodine the follow-up period would need to be lengthened to at least one year and beyond. Nonetheless, given the significant impact that OAB has on quality of life in older women, the risks of treatment with anticholinergic medications are often outweighed by the benefits received by them, and this study provides valuable preliminary data regarding the effects of fesoterodine in this elderly female population. In patients who are not candidates for anticholinergic medications due to fall risk or cognition, clinicians can consider mirabegron or third-line therapy as alternatives.
Presented by: Christine Chu, MD, Washington University School of Medicine in St. Louis,MO
Written by: Dena Moskowitz, MD; Assistant Professor of Clinical Urology, University of California Irvine; @demoskowitz at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
Reference:
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