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

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.

Obstetrics and gynecology. 2021 Feb 04 [Epub ahead of print]

Christina M Escobar, Kerac N Falk, Shailja Mehta, Evelyn F Hall, Kimia Menhaji, Elisabeth C Sappenfield, Oluwateniola E Brown, Nancy E Ringel, Olivia H Chang, Laura M Tellechea, Hayley C Barnes, Sarah E S Jeney, Alaina T Bennett, Olivia O Cardenas-Trowers

Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology and Obstetrics and Gynecology, New York University, New York, New York; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia; the Department of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, New Haven, Connecticut; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Women & Infants Hospital of Brown University, Providence, Rhode Island; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, Connecticut; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC; the Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Montefiore Medical Center and Albert Einstein School of Medicine, Bronx, New York; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Loyola University, Chicago, Illinois; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Irvine, California; the Division of Urogynecology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, Kentucky.

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