In the present study, we investigated the factors that influence the selection of anticholinergic drugs or β3 adrenergic agonists for OAB in the real world.
This was a retrospective study, which used data extracted from electronic records. Between January 2013 and December 2014, 109 patients who had been diagnosed with OAB were included in this study. The administered medications, clinical symptoms, and various lifestyle factors were evaluated retrospectively. We grouped the subjects into those that were prescribed anticholinergic drugs (group A) and those that were prescribed β3 adrenergic agonists (group B). We investigated the continuation/discontinuation of anticholinergic drug and β3 adrenergic agonist treatment. However, we could not examine the reasons for discontinuation.
We evaluated 75 patients (29 in group A and 46 in group B) that were prescribed anticholinergic drugs or β3 adrenergic agonists by our department. There were no significant differences in age, BMI, obesity, medical history, the pretreatment total OABSS, or the pretreatment scores for individual OABSS factors. The mean pretreatment PVR was significantly greater in group A than in group B (22 ml vs. 9 ml, respectively; P=0.0252). The one-year persistence rate of prescriptions from our department was 28% in both groups.
To the best of our knowledge, this is the first study to investigate this among OAB patients. While there has been some debate about the usage of different anticholinergic drugs, there was insufficient discussion and there are no clear indicators or guidelines regarding the usage of anticholinergic drugs versus β3 adrenergic agonists. Therefore, individual medications are being administered for OAB without any particular reason in real-world practice, and it seems that choices between anticholinergic drugs and β3 adrenergic agonists are based on the treating doctor’s preferences and experience. We investigated the factors that influence the selection of anticholinergic drugs and β3 adrenergic agonists in the real-world. In the present study the pretreatment PVR was significantly higher in patients who were prescribed anticholinergics compared to those who were treated with β3 adrenergic agonists, but this finding seemed to be of limited clinical significance because it was related to only three patients with high PVR taking anticholinergics. Regarding non-medical factors, a study reported that when physicians received complimentary meals and hospitality by a pharmaceutical company they increased their prescriptions of drugs marketed by that company.2 Although this may have affected our prescription patterns, we do not have any information about this in the present study. This could be an important subject for further study, including other oral medications.
There were no significant differences in clinical characteristics of patients who were prescribed anticholinergics and β3 adrenergic agonists for OAB treatment, but a marginal difference of PVR value before treatment. The 1-year persistence rates of anticholinergic drugs and β3 adrenergic agonists were considered to be almost equivalent.
Written by: Hiroshi Masuda, MD, Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
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