Kachru Nandita, Holmes Holly M, Johnson Michael L, Chen Hua, Aparasu Rajender R
Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy , University of Houston, Houston, TX, USA.
Division of Geriatric and Palliative Medicine, McGovern Medical School at UTHealth, Houston, TX, USA.
J Gen Intern Med. 2020 Jul;35(7):2084-2093. doi: 10.1007/s11606-020-05634-3. Epub 2020 Feb 5.
Selective antimuscarinics may offer a favorable safety profile over non-selective antimuscarinics for the management of overactive bladder (OAB) in patients with dementia.
To test the hypothesis that non-selective antimuscarinics are associated with increased risk of mortality compared to selective antimuscarinics in older adults with dementia and OAB.
Propensity score-matched retrospective new-user cohort design among Medicare beneficiaries in community settings.
Older adults with dementia and OAB with incident antimuscarinic use.
The primary exposure was antimuscarinic medications classified as non-selective (oxybutynin, tolterodine, trospium, fesoterodine) and selective (solifenacin, darifenacin) agents. All-cause mortality within 180 days of incident antimuscarinic use formed the outcome measure. New users of non-selective and selective antimuscarinics were matched on propensity scores using the Greedy 5 → 1 matching technique. Cox proportional-hazards model stratified on matched pairs was used to evaluate the risk of mortality associated with the use of non-selective versus selective antimuscarinics in the sample.
The study identified 16,955 (77.6%) non-selective antimuscarinic users and 4893 (22.4%) selective antimuscarinic users. Propensity score matching yielded 4862 patients in each group. The unadjusted mortality rate at 180 days was 2.6% (126) for non-selective and 1.6% (78) for selective antimuscarinic users in the matched cohort (p value < 0.01). The Cox model stratified on matched pairs found 50% higher risk of 180-day mortality with non-selective antimuscarinics as compared to selective ones (hazard ratio (HR) 1.50; 95% confidence interval (CI) 1.04-2.16). The study findings remained consistent across multiple sensitivity analyses.
Use of non-selective antimuscarinics was associated with a 50% increase in mortality risk among older adults with dementia and OAB. Given the safety concerns regarding non-selective antimuscarinic agents, there is a significant need to optimize their use in the management of OAB for older patients with dementia.
在治疗痴呆症患者的膀胱过度活动症（OAB）时，与非选择性抗毒蕈碱药物相比，选择性抗毒蕈碱药物可能具有更好的安全性。
检验以下假设：在患有痴呆症和OAB的老年人中，与选择性抗毒蕈碱药物相比，非选择性抗毒蕈碱药物会增加死亡风险。
在社区环境中的医疗保险受益人中进行倾向评分匹配的回顾性新用户队列设计。
患有痴呆症和OAB且首次使用抗毒蕈碱药物的老年人。
主要暴露因素为分类为非选择性（奥昔布宁、托特罗定、曲司氯铵、非索罗定）和选择性（索利那新、达非那新）药物的抗毒蕈碱药物。首次使用抗毒蕈碱药物后180天内的全因死亡率构成结局指标。使用贪婪5→1匹配技术对非选择性和选择性抗毒蕈碱药物的新用户进行倾向评分匹配。使用按匹配对分层的Cox比例风险模型来评估样本中使用非选择性与选择性抗毒蕈碱药物相关的死亡风险。
该研究确定了16955名（77.6%）非选择性抗毒蕈碱药物使用者和4893名（22.4%）选择性抗毒蕈碱药物使用者。倾向评分匹配后每组有4862名患者。在匹配队列中，非选择性抗毒蕈碱药物使用者180天的未调整死亡率为2.6%（126例），选择性抗毒蕈碱药物使用者为1.6%（78例）（p值<0.01）。按匹配对分层的Cox模型发现，与选择性抗毒蕈碱药物相比，非选择性抗毒蕈碱药物导致180天死亡的风险高50%（风险比（HR）1.50；95%置信区间（CI）1.04 - 2.16）。在多项敏感性分析中，研究结果保持一致。
在患有痴呆症和OAB的老年人中，使用非选择性抗毒蕈碱药物会使死亡风险增加50%。鉴于对非选择性抗毒蕈碱药物安全性的担忧，在治疗患有痴呆症的老年患者的OAB时，非常有必要优化其使用。
