Clinical Features and Current Pharmacotherapy of OAB in Practice: Ideal and Reality

The present study aimed to investigate the prescribing patterns of anticholinergics (anti-AChR) or β3-adrenergic agonists (β₃A) 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 β₃A, 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 β₃A; among men (51.5%; 36,497), 17.1% initially received anti-AChR and 34.3% received β₃A. 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 β₃A 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 β₃A in both women (12.39) and men (13.65). In the multivariable analysis, initial prescription with anti-AChR compared with β₃A did not show any association with the risk of AEs.

This large-scale database study revealed that treatment for OAB is often initiated with β₃A 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.