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OBJECTIVE: Increasing anticholinergic burden (ACB), especially in older adults, may be associated with increased risk of adverse outcomes. This analysis quantified the contribution of overactive bladder (OAB) anticholinergic medications (ACHs) to total ACB and the association of time-varying ACB with health outcomes in patients with OAB. METHODS: This retrospective study used medical and pharmacy claims from the Optum Research Database to identify adults with ≥ 1 pharmacy claim for ≥ 1 of 6 OAB ACHs from January 2010-November 2021. Patients had continuous enrollment in a commercial or Medicare Advantage plan with pharmacy and medical benefits for ≥6 months preindex (baseline) and postindex and were followed until disenrollment or 31 May 2022. Each ACH was assigned a burden score per established burden values and quantity received. Patient's daily ACB was categorized as 0 (< 0.5), 1 (≥ 0.5, < 1.5), 2 (≥ 1.5, < 2.5), 3 (≥ 2.5, < 3.5), or ≥ 4 (> 3.5) points/day. The mean ratio of OAB ACB to total ACB over follow-up was calculated. Adverse health outcomes assessed were: urinary tract infection (UTI), incontinence-associated dermatitis, urinary retention, delirium/drowsiness, cognitive impairment, falls/fractures, cardiovascular events, and mortality. The association between postindex event risk and ACB was analyzed with a time-varying Cox proportional hazard model to account for varying ACB and patient characteristics. RESULTS: In total, 428,142 patients were identified. Mean age was 65.2 years, 66.7% were female, mean (SD) baseline ACB was 0.53 (1.44), and mean (SD) follow-up was 1096 (862) days. Overall, 61% of ACB was attributable to OAB medications. Adjusted hazard ratios (HR) for UTI, urinary retention, delirium/drowsiness, cognitive impairment, fall/fractures, and cardiovascular events were >1 for all ACB categories (vs 0 points/day) and increased with ACB. Cognitive impairment had the highest association with ACB (HR range, 1.182-1.551). CONCLUSION: This analysis shows an association between increased ACB and greater risk of adverse health outcomes. OAB ACHs are a major contributor to total ACB in patients treated with OAB ACHs. [ABSTRACT FROM AUTHOR]

Introduction: Overactive bladder (OAB) management with pharmacotherapy is limited by low real-world adherence and persistence. This analysis compared real-world adherence and persistence of patients initiating vibegron, a 3-adrenergic receptor agonist approved in December 2020 for OAB, with mirabegron and anticholinergics. Methods: This retrospective study used pharmacy claims data from the Optum Research Database. Study criteria included patients ≥18 years old with ≥1 pharmacy claim for vibegron, mirabegron, or anticholinergic from April 1, 2021--December 31, 2021; continuous enrollment in a health plan with pharmacy and medical benefits for 3 months preindex (baseline) and ≥2 months postindex (follow-up); and no index medication during baseline. Two independent propensity-score models were used to match patients treated with (1) vibegron vs mirabegron and (2) vibegron vs anticholinergics. Adherence was measured by proportion of days covered (PDC) from index to end of follow-up and defined as PDC ≥80%. Persistence was defined as days to discontinuation of index medication or end of follow-up. Adherence and persistence were analyzed descriptively and by Kaplan-Meier analysis, respectively. Results: The matched vibegron and mirabegron cohorts included 1655 and 3310 patients, respectively; the matched vibegron and anticholinergic cohorts included 1595 and 3190 patients. Patients receiving vibegron had greater adherence vs patients receiving mirabegron (PDC=0.71 vs 0.68, respectively; P=0.004) or anticholinergics (0.71 vs 0.61; P<0.001). A greater percentage of patients receiving vibegron were adherent (ie, PDC ≥80%) vs those receiving mirabegron (53.4% vs 49.2%, respectively; P=0.005) or anticholinergics (53.7% vs 43.2%; P<0.001). Persistence was longer with vibegron vs mirabegron (median [95% CI]; 205 [162-246] vs 148 [126-162] days, respectively; P<0.001) and anticholinergics (207 [167-246] vs 91 [91- 95] days; P<0.001). Conclusions: In this retrospective analysis, real-world adherence and persistence was higher in patients initiating vibegron compared with patients initiating mirabegron or anticholinergic when matched on baseline characteristics. [ABSTRACT FROM AUTHOR]