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. 2021 May;36(5):684-696.
doi: 10.1002/gps.5467. Epub 2020 Nov 18.

Comparative risk of adverse outcomes associated with nonselective and selective antimuscarinic medications in older adults with dementia and overactive bladder

Nandita Kachru  1 , Holly M Holmes  2 , Michael L Johnson  1 , Hua Chen  1 , Rajender R Aparasu  1
Affiliations

Comparative risk of adverse outcomes associated with nonselective and selective antimuscarinic medications in older adults with dementia and overactive bladder

Nandita Kachru et al. Int J Geriatr Psychiatry. 2021 May.

Abstract

Objective: The differential muscarinic receptor selectivity could cause selective antimuscarinics to offer advantages over nonselective agents with respect to adverse effects. The objective was to examine the comparative risk of falls/fractures and all-cause hospitalizations among older adults with dementia and overactive bladder (OAB) using nonselective and selective antimuscarinics METHODS/DESIGN: A retrospective cohort study design was conducted among older patients with dementia and OAB using incident antimuscarinics. The primary exposure was classified as nonselective (oxybutynin, tolterodine, trospium, and fesoterodine) and selective (solifenacin and darifenacin). Cox proportional-hazards regression using inverse probability of treatment weighting (IPTW) evaluated the risk of falls/fractures and all-cause hospitalizations within 6 months of nonselective and selective antimuscarinic use.

Results: The study cohort consisted of 13,896 (76.9%) nonselective and 4,179 (23.1%) selective antimuscarinic incident users. The unadjusted falls/fractures rate was 27.14% (3,772) for nonselective and 24.55% (1,026) for selective users (p-value< 0.01). The unadjusted all-cause hospitalizations rate was 24.14% (3,354) for nonselective and 21.58% (902) for selective users (p-value <0.01). The IPTW models did not find a significant difference in the risk of falls/fractures (Hazard Ratio [HR] 1.03; 95% Confidence Interval [CI] 0.99-1.07) and risk of all-cause hospitalizations (HR 1.04; 95% CI 0.99-1.08) between nonselective and selective antimuscarinics. Several sensitivity analyses corroborated the main findings.

Conclusions: The study did not find a differential risk of falls/fractures and all-cause hospitalizations in older adults with dementia and OAB using nonselective and selective antimuscarinics. More research is needed to understand the role of pharmacodynamics and pharmacokinetics in the safety profile of antimuscarinics in dementia.

Keywords: OAB; dementia; falls/fractures; hospitalizations; muscarinic receptors; nonselective antimuscarinics; receptor selectivity; selective antimuscarinics.

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Figures

Figure 1.
Figure 1.
Incident Antimuscarinic Use Study Design
Figure 2.
Figure 2.
Patient Attrition Flowchart
Figure 3.
Figure 3.
Kaplan–Meier curve depicting the association between non-selective and selective antimuscarinic medication users and risk of falls/fractures
Figure 4.
Figure 4.
Kaplan–Meier curve depicting the association between non-selective and selective antimuscarinic medication users and risk of all-cause hospitalizations
See this image and copyright information in PMC

References

    1. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010; 29 (1): 4–20 - PubMed
    1. Resnick NM, Yalla SV, Laurino MS. The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med. 1989; 320: 1–7 - PubMed
    1. Haab F. Chapter 1: The conditions of neurogenic detrusor overactivity and overactive bladder. Neurourol Urodyn. 2014; 33 Suppl 3: S2–5 - PubMed
    1. Andersson KE. Antimuscarinics for treatment of overactive bladder. Lancet Neurol. 2004; 3(1): 46–53 - PubMed
    1. Glavind K, Chancellor M. Antimuscarinics for the treatment of overactive bladder: understanding the role of muscarinic subtype selectivity. Int Urogynecol J. 2011; 22(8): 907–17 - PubMed

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