Discontinuation of Treatment Using Anticholinergic Medications in Patients With Urinary Incontinence

OBJECTIVE: To evaluate the discontinuation rates of anticholinergics prescribed in patients with urinary incontinence (UI). METHODS: Data from a Disease Analyzer database including 988 general, 95 urologist, and 203 gynecologic practices were examined. Twenty six thousand eight hundred thirty-four patients were identified as having received a first-time anticholinergic prescription for UI, namely darifenacin, fesoterodine, oxybutynin, propiverine, solifenacin, tolterodine, or trospium, between 2005 and 2012. Covariates studied included demographic data, concomitant diagnoses, and potential drug-induced side effects. The cumulative discontinuation rate of initial treatment was estimated using a Kaplan-Meier analysis. A Cox proportional hazard regression model was used to estimate the relationship between discontinuation and the demographic and clinical variables for up to 36 months. RESULTS: An increasing discontinuation rate was observed in years 1, 2, and 3 (74.8%, 77.6%, 87%). Within 3 years, discontinuation rates were higher for men than for women (87.9%, 86.5%; P=.056; hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.11-1.18; P<.001), for patients treated in gynecologic practices and general practices than those treated in urologist practices (HR 1.60; 95% CI 1.52-1.67, P<.001 and HR 1.24, 95% CI 1.20-1.29, P<.001, respectively) and for younger patients than those older than 80 year old (60 years or younger, HR 1.27, 95% CI 1.22-1.33; 61-70 years, HR 1.16, 95% CI 1.11-1.21; 71-80 years, HR 1.14, 95% CI 1.09-1.18, P<.001). Those using propiverine or solifenacin were less likely to discontinue treatment than those using oxybutynin (HR 0.94, 95% CI 0.88-0.99, P=.024 and HR 0.93, 95% CI 0.87-0.98, P=.004, respectively). CONCLUSION: Patients with UI demonstrate high discontinuation rates for anticholinergics with only slight variations between the various drugs in this category.