From the Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
Department of Health Management and Policy, Drexel University, Philadelphia, PA.
Female Pelvic Med Reconstr Surg. 2020 Jul;26(7):431-436. doi: 10.1097/SPV.0000000000000811.
The aims of this study are to determine how long it takes female patients with overactive bladder (OAB) to receive third-line treatment after starting OAB medications and identify factors associated with increased time.
This was a retrospective observational cohort study of adult female patients with OAB who received third-line treatment between 2013 and 2015 using insurance claims databases. Primary outcome was time between first OAB medication and first third-line treatment. Additional variables were patient demographics, diagnostic tests, and medical comorbidities.
Of 3232 patients included in this study, 48.8% underwent sacral neuromodulation, 31.6% percutaneous tibial nerve stimulation, and 23% intradetrusor onabotulinumtoxin A injections. Twenty-one percent of patients filled medication prescriptions for 3 or more antimuscarinic medications, 30.4% took mirabegron, and 32.3% had advanced diagnostic tests suggestive of a specialist evaluation prior to starting medications. Median time to third-line treatment was 37.7 (interquartile range, 14.9, 16.3) months. Adjusted linear regression model revealed 2 predominant predictors of time to third-line treatments: each antimuscarinic medication trial was associated with 5.3 (95% confidence interval, 4.4-6.3) more months before third-line treatment (P < 0.001), and advanced diagnostic evaluations prior to starting medications were associated with 28.2 (95% confidence interval, 21-35) fewer months before third-line treatment (P < 0.001).
Women with OAB who undergo third-line therapy do so on average more than 3 years after starting medications. Time to third-line treatment is largely driven by the number of antimuscarinic medications tried and timing of diagnostic evaluation by a specialist. Based on these results, we suggest providers consider limiting antimuscarinic trials to 2 medications prior to moving on to other treatment options.
本研究旨在确定患有膀胱过度活动症（OAB）的女性患者在开始使用 OAB 药物后接受三线治疗需要多长时间，并确定与延长时间相关的因素。
这是一项回顾性观察性队列研究，纳入了 2013 年至 2015 年期间使用保险索赔数据库接受三线治疗的成年女性 OAB 患者。主要结局是首次 OAB 药物治疗与首次三线治疗之间的时间。其他变量包括患者人口统计学特征、诊断性检查和合并症。
本研究共纳入 3232 例患者，其中 48.8%接受了骶神经调节，31.6%接受了经皮胫神经刺激，23%接受了膀胱内注射肉毒毒素 A。21%的患者开具了 3 种或以上抗毒蕈碱药物的处方，30.4%的患者服用米拉贝隆，32.3%的患者在开始药物治疗前进行了高级诊断性检查，提示需要专家评估。三线治疗的中位时间为 37.7（四分位距，14.9，16.3）个月。调整后的线性回归模型显示，三线治疗时间的 2 个主要预测因素为：每次抗毒蕈碱药物试验与三线治疗前增加 5.3（95%置信区间，4.4-6.3）个月（P < 0.001），开始药物治疗前进行高级诊断性评估与三线治疗前减少 28.2（95%置信区间，21-35）个月（P < 0.001）。
接受三线治疗的 OAB 女性患者平均在开始药物治疗 3 年以上后才接受治疗。三线治疗时间主要取决于尝试的抗毒蕈碱药物数量和专家进行诊断性评估的时间。基于这些结果，我们建议医生在选择其他治疗方案之前，将抗毒蕈碱药物试验限制在 2 种药物以内。
