(78) Time Trends in The Prescription of Overactive Bladder Agents in England

Publication Number: 409

Background: Overactive bladder (OAB) is characterized by urinary urgency, frequency and nocturia, with or without incontinence, and significantly reduces quality of life. Anticholinergic medications (oxybutynin, solifenacin, and tolterodine) and a beta-3 adrenergic receptor agonist, mirabegron, are the first line pharmacologic agents for the treatment of OAB in England, despite limited effectiveness. However, there are concerns that anticholinergic medications are associated with cognitive decline and incident dementia.

Objectives: To describe the utilization of OAB medications in England in adults aged 50 years and older between 2000-2019 by age, sex, and drug.

Methods: We estimated the prevalence of prescribed OAB treatment from 75.7 million person-years of registration aged over 50 between 2000-2019 at general practices in England from the Clinical Practice Research Datalink Aurum database, stratified by year, age group (50-59, 60-69, 70-79, 80+ years), sex, and drug.

Results: Between 2000 and 2019, there was an increase in the number of men prescribed OAB medications from 11 to 24 per 1000 person-years (PY) and in women from 17 to 39 per 1000 PY. Medication use increased linearly with age group. In 2019, of those aged 50-59 years there were 8 men and 23 women per 1000 PY prescribed OAB medications while of those aged 80 years or older, 60 men and 65 women were prescribed OAB medications per 1000 PY. Between 2005 and 2019, prescriptions for solifenacin increased (from 3% of prescribed OAB agents in 2005 to 33% in 2019), whilst declining preference was observed for tolterodine (from 50% to 18% of prescriptions) and oxybutynin (from 37% to 18%). Prescribing of mirabegron has also increased since 2013 (from 1% of OAB prescriptions in 2013 to 20% in 2019).

Conclusions: The proportion of patients prescribed overactive bladder agents has more than doubled in England over the past 20 years, with women and older patients receiving more prescriptions. Increased prescribing in older adults raises concerns, due to age-related changes in pharmacodynamics increasing vulnerability to reported side-effects including possible long-term cognitive decline. Although prescribing appears to be switching towards agents with a purported favourable cognitive profile, evidence as to whether mirabegron shares similar associations with cognitive decline as anticholinergics is lacking.