Trends in Overactive Bladder Prescriptions from 2020 to 2022

Objectives: Anticholinergic (AC) and Beta-3 agonist (B3) medications are the mainstay of pharmacotherapy to treat overactive bladder (OAB). However, there is growing concern regarding the risk of cognitive impairment with AC. In February 2021, the American Urogynecology Society released an updated statement cautioning the use of AC especially in elderly patients. Vibegron received Food and Drug Administration approval and became the second available B3 medication for the treatment of OAB in April 2021. The primary objective of this study was to examine OAB prescribing patterns from 2020 to 2022 given the updated clinical guidelines and newly available alternatives to AC.

Methods: This was a retrospective study at two large, academic centers between January 2020 and December 2022. Female patients at least 18 years old diagnosed with OAB and newly prescribed AC or B3 for OAB were included. OAB diagnosis was identified using ICD-10 codes and the electronic medical record was queried for new OAB medication prescriptions in the health system. Patient demographics and provider specialty were abstracted from the medical record. Group comparisons were conducted using student’s t-test and chi square Fisher’s exact test as appropriate.

Results: Between 2020 and 2022, 12,162 patients were prescribed a new AC or B3 medication. The majority of OAB prescriptions were AC (64.4%). Older, white patients were more likely to be prescribed B3 medications (p < 0.001). 50.8% of white patients prescribed an OAB medication were given AC compared to 83.2% of Black patients. Publicly insured patients were more likely to receive a B3 prescription while patients with private insurance were more likely to receive an AC prescription (p < 0.001). Provider specialty was significantly different between B3 and AC prescriptions (p < 0.001). Although primary care physicians (PCP) prescribed the most medications for OAB, urogynecologists were the leading prescribers of B3 (33.8%), while PCPs prescribed the most AC (38.6%). Overall B3 prescriptions increased by 137% in 2022 compared to 2020. AC prescriptions increased by 16% in 2022 compared to 2020. When comparing 2020 and 2022 OAB prescriptions by provider specialty, percentage of B3 prescriptions increased for all specialties and percentage of AC prescriptions decreased (p < 0.001).

Conclusions: Consistent with updated guidelines, B3 prescriptions for OAB increased while AC prescriptions decreased substantially between 2020 and 2022. However, nearly 2/3 of OAB medication prescriptions were still AC. Black women were more likely to be given an AC despite the increased risks of cognitive dysfunction. Further research and education initiatives with an equity lens are needed to minimize AC risks to women with OAB.