Prescribing of Overactive Bladder Medications After Consensus Statements

Objectives: The 2017 and September 2020 American Urogynecologic Society consensus statements recommended the use of anticholinergic medications should be avoided in women older than 70 years and alternative medications such as beta-3 agonists should be considered for treatment of overactive bladder (OAB). The objective of this study was to determine if women aged 70 years and older were more likely to receive beta-3 agonists compared to women under the age of 70 years before and after each of the consensus statements were released.

Methods: This is a retrospective cohort study of women who were prescribed medication to treat OAB in a regional health system from 1/1/2014 to 12/31/2023. The cohorts were separated by age at first pharmacologic treatment for OAB: 1) women > 70 years; and 2) women < 70 years. Our primary outcome was type of OAB medication. Demographic, provider, and prescription data were compared between the two groups from 2014 - 2016 before the consensus statements, from 2017 - 2020 after the 2017 statement, and from 2021 – 2023 after the September 2020 statement. Prescription patterns were compared between groups using Chi-square test. Multivariable logistic regression was performed to adjust for potential confounders.

Results: There were 11,704 women who were prescribed OAB medications in this study. The mean age was 65 years (SD 15.1 years) and 85% were white. Over the study period, there was no significant difference in the number of beta-3 agonist prescriptions for women over the age of 70 years compared to women less than 70 years (p = 0.1837). The overall number of prescriptions for beta-3 agonists did increase relative to older generation anti-cholinergics (p < 0.01). Beta-3 agonists prescriptions increased by 16.1% following the 2017 consensus statement with a 10.1% drop in older generation anti-cholinergic prescriptions. Following the 2020 consensus statement, there was a further 9.1% increase for beta-3 agonists and a further 9.1% decrease for older generation anti-cholinergics (Figure 1). When analyzing the data by provider specialty, urologists and primary care physicians (PCPs) were less likely to prescribe beta-3 agonists compared to obstetrician gynecologists (ob/gyns) and their associated sub-specialists (aOR 0.207 [95% CI 0.180-0.237] PCPs, and aOR 0.723 [95% CI 0.623-0.840] urologists).

Conclusions: There has been an increase in beta-3 agonist prescriptions since both the 2017 and 2020 consensus statements for all patients, not only those over the age of 70 years. In this study, ob/gyns were more likely to prescribe beta-3 agonists. While more beta-3 agonists are being prescribed, there are still a significant number of anti-cholinergics being prescribed. Additional research is needed on barriers to providers prescribing and patients obtaining beta-3 agonists.