University of Florida College of Pharmacy, Department of Pharmaceutical Outcomes & Policy, PO Box 100496, Gainesville, FL 32610-0496, United States; University of Florida Health Physicians, PO BOX 100354, Gainesville, FL 32610-0354, United States.
SSM Health, Department of Clinical Analytics and Insights, 10101 Woodfield Lane, St. Louis, MO 63132, United States.
Arch Gerontol Geriatr. 2019 Jan-Feb;80:1-11. doi: 10.1016/j.archger.2018.09.005. Epub 2018 Sep 22.
Although antimuscarinics are typically the first-line pharmacological treatment option for overactive bladder, patients often discontinue therapy. The aim of this research project is to identify the rate of antimuscarinic discontinuation, switching, and continuation and differences in discontinuation among different antimuscarinics.
Using the 5% random sample of Medicare Claims Data, we identified a cohort of patients aged ≥ 66 years old who newly initiated antimuscarinics between January 1, 2007 and December 31, 2012. Treatment discontinuation was defined as no subsequent fills of the initial antimuscarinic in the days' supply plus a 30 day grace period. We ascertained percentages of patients who discontinued antimuscarinics, switched antimuscarinics, or died within 12 months of antimuscarinic initiation. Cox proportional hazards models were used to determine time to discontinuation of individual antimuscarinics relative to oxybutynin immediate-release (IR).
Among the 42,886 new-users of antimuscarinics, 71.8% discontinued, 10.8% switched, and 3.2% died prior to antimuscarinic discontinuation or switching while only 14.2% continually filled an antimuscarinic for one year. In the multivariable analysis, patients who were initiated on oxybutynin extended-released (ER), tolterodine, trospium, darifenacin, solifenacin, and fesoterodine were significantly less likely to be discontinued therapy compared to oxybutynin IR (p < 0.001).
After one year of antimuscarinic initiation, only 14% of older adult patients continuously utilized their initial antimuscarinic therapy suggesting a need for clinical interventions to improve continual use of antimuscarinics.
尽管抗毒蕈碱药物通常是治疗膀胱过度活动症的一线药物，但患者往往会停止治疗。本研究项目旨在确定抗毒蕈碱药物的停药、换药和继续使用率，以及不同抗毒蕈碱药物之间的停药差异。
我们使用 Medicare Claims Data 的 5%随机样本，确定了一组年龄≥66 岁的患者，他们在 2007 年 1 月 1 日至 2012 年 12 月 31 日期间首次使用抗毒蕈碱药物。停药定义为初始抗毒蕈碱药物在供应天数内没有后续配药，并且在 30 天宽限期内没有后续配药。我们确定了在抗毒蕈碱药物起始后 12 个月内停止使用抗毒蕈碱药物、换药或死亡的患者比例。使用 Cox 比例风险模型确定与奥昔布宁即时释放 (IR) 相比，个体抗毒蕈碱药物的停药时间。
在 42886 名新使用抗毒蕈碱药物的患者中，71.8%停药，10.8%换药，3.2%在抗毒蕈碱药物停药或换药前死亡，而只有 14.2%的患者持续使用抗毒蕈碱药物一年。在多变量分析中，与奥昔布宁 IR 相比，使用奥昔布宁缓释 (ER)、托特罗定、曲司氯铵、达非那新、索利那新和非索那新的患者停药治疗的可能性显著降低 (p<0.001)。
在开始抗毒蕈碱药物治疗一年后，只有 14%的老年患者持续使用他们的初始抗毒蕈碱药物治疗，这表明需要采取临床干预措施来提高抗毒蕈碱药物的持续使用。
