Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, USA.
Astellas Pharma Global Development, Inc., Northbrook, IL, USA.
Adv Ther. 2020 Aug;37(8):3584-3605. doi: 10.1007/s12325-020-01412-z. Epub 2020 Jul 7.
Although antimuscarinics form the first-line therapy in overactive bladder (OAB), little is known regarding antimuscarinic discontinuation among OAB patients in nursing homes. This study examined treatment patterns and predictors of antimuscarinic discontinuation among long-term nursing home (LTNH) residents with OAB.
The study cohort included LTNH residents (defined as residents staying ≥ 101 consecutive days) from the Minimum Data Set linked 2013-2015 Medicare claims data. Patients with OAB were defined by OAB-related claims and medication codes. Treatment patterns and discontinuation (medication gap ≥ 30 days) were characterized by examining OAB-specific antimuscarinics prescribed during LTNH stays. The Andersen Behavioral Model was used to identify predisposing, enabling and need factors that predict discontinuation. Kaplan-Meier curves and multivariable Cox proportional hazards regression model were used to assess the unadjusted and adjusted times to discontinuation, respectively, among different antimuscarinics.
The mean age of the study cohort (n = 11,012) was 81.6 years (± 8.5), 74.6% were female, and 89.8% were non-Hispanic White. The mean duration of nursing home stay was 530.1 (± 268.4) days. The most commonly prescribed OAB-specific antimuscarinic was oxybutynin (69.8%). Overall, 66.5% of the study cohort discontinued the index antimuscarinic. Multivariable Cox PH regression analysis revealed that compared to LTNH residents who initiated treatment with oxybutynin, treatment discontinuation was lower with solifenacin or fesoterodin and discontinuation was more frequent when treatment was initiated with tolterodine, darifenacin or trospium compared with oxybutynin. In addition, several need factors (comorbidities, medication use and anticholinergic burden, etc.) were associated with antimuscarinic discontinuation.
About two-thirds of LTNH residents with OAB discontinued their index antimuscarinic during their nursing home stay. There was significant variation in discontinuation based on the index antimuscarinic agent with lowest risk of discontiuation with solifenacin and fesoterodin. Concerted efforts to optimize antimuscarinic use are needed to improve the management of OAB in nursing homes.
虽然抗毒蕈碱药物是治疗膀胱过度活动症（OAB）的一线疗法，但对于疗养院中 OAB 患者抗毒蕈碱药物的停药情况知之甚少。本研究旨在探讨长期疗养院（LTNH）中 OAB 患者抗毒蕈碱药物的治疗模式和停药预测因素。
本研究队列纳入了与 2013-2015 年医疗保险索赔数据相关联的最小数据集（Minimum Data Set）中的 LTNH 居民（定义为连续入住≥101 天的居民）。OAB 患者的定义是根据 OAB 相关的索赔和药物代码。通过检查 LTNH 期间开的 OAB 特异性抗毒蕈碱药物，描述了治疗模式和停药（药物间隔≥30 天）。安德森行为模型被用来识别预测停药的倾向、赋权和需求因素。采用 Kaplan-Meier 曲线和多变量 Cox 比例风险回归模型分别评估不同抗毒蕈碱药物的未调整和调整停药时间。
研究队列（n=11012）的平均年龄为 81.6 岁（±8.5），74.6%为女性，89.8%为非西班牙裔白人。疗养院的平均入住时间为 530.1 天（±268.4）。最常开的 OAB 特异性抗毒蕈碱药物是奥昔布宁（69.8%）。总体而言，研究队列中有 66.5%的患者停止了指数抗毒蕈碱药物的治疗。多变量 Cox PH 回归分析显示，与开始用奥昔布宁治疗的 LTNH 居民相比，用索利那新或非索罗定治疗的停药率较低，而与奥昔布宁相比，用托特罗定、达非那新或曲司氯铵开始治疗的停药率更高。此外，一些需求因素（合并症、药物使用和抗胆碱能负担等）与抗毒蕈碱药物的停药有关。
大约三分之二的 LTNH 中有 OAB 的居民在疗养院期间停止了他们的指数抗毒蕈碱药物治疗。基于指数抗毒蕈碱药物，停药风险最低的是索利那新和非索罗定。需要共同努力优化抗毒蕈碱药物的使用，以改善疗养院中 OAB 的管理。
