Choosing oral drug therapy for overactive bladder in older people

ABSTRACT

Introduction: Overactive bladder (OAB) and urgency incontinence are common in older people. Nevertheless, there remains a paucity of prospectively collected data on the efficacy of commonly used drug treatments for the condition. Many trials have included older people, but have seldom reported results stratified by age or reported adverse events of particular relevance to older people in clinical practice. This has partially been rectified with the introduction of more recently introduced antimuscarinic agents, particularly fesoterodine, and the beta-3-agonist, mirabegron.

Areas covered: This article discusses evidence from recent trials relevant to robust and medically complex older people including synthesis of evidence on the association of anticholinergic medications and impaired cognition with relevance to OAB medications

Expert opinion: There are increasing data concerning pharmacological therapy in both robust and medically complex older adults. There is a need to explore the efficacy and tolerability of pharmacological treatment of OAB and UUI (urgency urinary incontinence) in specific subgroups and to produce confirmatory real-world data on efficacy and tolerability. Guidelines which address treatment of older people is currently sparse but, as time progresses and data improve, more specific guidance should become available.

KEYWORDS:

• Overactive bladder
• urgency incontinence
• comorbidity
• antimuscarinic

Article highlights

• Prospectively gathered data on the treatment of OAB-UUI in older adults are relatively sparse, but accumulating

• Older patients with OAB whether in the community or in nursing homes appear to have greater comorbidity and more impairments in activities of daily living than those without OAB, and OAB maybe an additional marker of impending frailty in older people

• Management of OAB-UUI in robust and medically complex older adults should address modifiable factors outside the lower urinary tract (e.g. mobility, medication review) which might have an impact on successful toileting

• Whereas oxybutynin immediate-release has been consistently associated with adverse cognitive events, data for the newer antimuscarinics suggest such reactions are rare and where tested, there has been no change in Mini-Mental State Examination associated with drug exposure over variable time periods for the newer antimuscarinics.

• Given the nature of OAB, and the predominance of people >65, often with comorbidities with the condition we should be looking for innovative ways of pushing the boundaries to gain real-life evidence for those with frailty, dementia diagnoses, or major coexisting conditions in later life.

This box summarizes key points contained in the article.

Declaration of interest

A Wagg reports speaker’s fees and funding for consultancy work and research from Astellas and Pfizer Inc. He has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.