Relative Risk of Adverse Events and Treatment Discontinuations Between Older and Non-Older Adults Treated with Antimuscarinics for Overactive Bladder: A Systematic Review and Meta-Analysis.

Overactive bladder (OAB) affects adults of all ages. The risk for medication-related adverse events (AEs) may differ between age groups, given age-related changes in pharmacokinetics and pharmacodynamics. No previous study has differentiated the risk of AEs between older and non-older adults with OAB.

Our objective was to assess the risk of AEs and treatment discontinuations between older and non-older adults with OAB initiated on an antimuscarinic.

We searched MEDLINE (PubMed interface), Embase, SCOPUS, and Cochrane Central Register for Controlled Trials in a previous analysis in February 2015 and repeated the search in August 2018, with no additional studies identified. Studies that delineated AEs or treatment discontinuations between the older and non-older (age <65 years) subjects were included.

Six studies that made nine comparisons between older and non-older subjects met the inclusion criteria. The AEs of dry mouth (46.7%), constipation (10.3%), and headache (7.7%) were most frequently reported. Older subjects were more likely to experience dry mouth (relative risk [RR] 1.09; 95% confidence interval [CI] 1.00-1.19), constipation (RR 1.92; 95% CI 1.52-2.43), dizziness (RR 2.37; 95% CI 1.21-4.62), and urinary retention (RR 4.17; 95% CI 1.76-9.89) than were non-older subjects. Headache was less likely to occur in older subjects (RR 0.58; 95% CI 0.40-0.86). Treatment discontinuations due to AEs were more likely to occur in the older subjects (RR 1.59; 95% CI 1.20-2.11).

Treatment of OAB with antimuscarinics in the older population resulted in significantly higher rates of AEs, barring headache, when compared with non-older subjects.

Drugs & aging. 2019 May 04 [Epub ahead of print]

Silken A Usmani, Kristine Reckenberg, Olivia Johnson, Paul M Stranges, Besu F Teshome, Clark D Kebodeaux, Scott Martin Vouri

College of Pharmacy, University of Florida, PO Box 100496, Gainesville, FL, 32610, USA., College of Pharmacy, St. Louis County Department of Public Health, St. Louis, MO, USA., Walmart Neighborhood Market, Mansfield, TX, USA., College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA., St. Louis College of Pharmacy, St. Louis, MO, USA., College of Pharmacy, University of Kentucky, Lexington, KY, USA., College of Pharmacy, University of Florida, PO Box 100496, Gainesville, FL, 32610, USA. .