Tsubouchi Kazuna, Arima Hisatomi, Emoto Taiki, Nakazawa Hiroshi, Kitano Takahiro, Mikami Masashi, Aoyagi Chikao, Matsuzaki Hiroshi, Tominaga Kosuke, Gunge Naotaka, Miyazaki Takeshi, Okabe Yu, Nakamura Nobuyuki, Fukuhara Yuichiro, Tachibana Masahiro, Nakagawa Chizuru, Yamazaki Fumihiro, Haga Nobuhiro
Department of Urology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan.
Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Adv Ther. 2025 Feb;42(2):1094-1107. doi: 10.1007/s12325-024-03070-x. Epub 2024 Dec 24.
The present study aimed to investigate the prescribing patterns of anticholinergics (anti-AChR) or β3-adrenergic agonists (βA) in the pharmacotherapy of overactive bladder (OAB) and to evaluate the differences in the frequency of adverse events (AEs) between the two types of drugs using a large-scale medical claims database.
This cohort study was conducted using the JMDC claims database between May 2015 and April 2023. Patient characteristics, prescription and treatment patterns of anti-AChR and βA, and the incidence of AEs have been described.
Overall, 70,936 patients were analyzed [mean age, 53.6 (standard deviation: 12.3) years]. Among women (48.5%; 34,439), 21.4% initially received anti-AChR and 27.2% received βA; among men (51.5%; 36,497), 17.1% initially received anti-AChR and 34.3% received βA. Most patients (79.6%; women, 83.5%; men, 75.8%) visited clinics. About 10% of patients had a treatment change: 5.6% switched the drug type (change from anti-AChR to βA or vice versa), and 4.0% had an add-on of another drug type. The incidence rate of treatment change per 100 patient-years was higher with βA in both women (12.39) and men (13.65). In the multivariable analysis, initial prescription with anti-AChR compared with βA did not show any association with the risk of AEs.
This large-scale database study revealed that treatment for OAB is often initiated with βA and prescribed mainly at clinics. Changes or additions to initial prescriptions were as low as about 5%, indicating that raising awareness among physicians treating OAB is particularly important to improve the quality of life of patients with OAB. Our study also showed that the incidence of AEs was not associated with the initially prescribed drug type. Continued exploration is warranted to further clarify the risk of AEs with each prescription.
本研究旨在调查抗胆碱能药物（抗AChR）或β3肾上腺素能激动剂（βA）在膀胱过度活动症（OAB）药物治疗中的处方模式，并使用大规模医疗理赔数据库评估这两种药物不良事件（AE）发生频率的差异。
本队列研究使用2015年5月至2023年4月期间的JMDC理赔数据库进行。描述了患者特征、抗AChR和βA的处方及治疗模式，以及AE的发生率。
总体而言，共分析了70936例患者[平均年龄53.6（标准差：12.3）岁]。在女性患者中（48.5%；34439例），21.4%最初接受抗AChR治疗，27.2%接受βA治疗；在男性患者中（51.5%；36497例），17.1%最初接受抗AChR治疗，34.3%接受βA治疗。大多数患者（79.6%；女性为83.5%，男性为75.8%）前往诊所就诊。约10%的患者有治疗变更：5.6%更换了药物类型（从抗AChR更换为βA或反之），4.0%加用了另一种药物类型。βA在女性（12.39）和男性（13.65）中的每100患者年治疗变更发生率均较高。在多变量分析中，与βA相比，最初使用抗AChR处方与AE风险无任何关联。
这项大规模数据库研究表明，OAB治疗通常起始于βA，且主要在诊所开具处方。初始处方的变更或加用率低至约5%，这表明提高治疗OAB的医生的认识对于改善OAB患者的生活质量尤为重要。我们的研究还表明，AE的发生率与最初开具的药物类型无关。有必要继续探索以进一步明确每种处方的AE风险。
