Some Meds for Overactive Bladder Tied to Dementia

Susan London | 09 December 2024

TOPLINE:

In middle-aged and older adults with overactive bladder, the drug selected for treatment may influence the risk for dementia.

METHODOLOGY:

Investigators conducted a nested case-control study using data from general practices in England captured in the Clinical Practice Research Datalink GOLD.
They compared 170,742 patients aged ≥ 55 years with a first diagnosis of dementia and 804,385 dementia-free individuals matched on age, sex, and general practice.
Analyses assessed the exposure to eight anticholinergic drugs and one non-anticholinergic drug (mirabegron) used for overactive bladder treatment in the 3-16 years before dementia diagnosis.

TAKEAWAY:

Use of any anticholinergic drug conferred a significant 18% increase in the risk for dementia (adjusted odds ratio, 1.18).
Men had a greater elevation of risk than women (adjusted odds ratio, 1.22 vs 1.16).
In analyses considering lower and higher total standardised daily doses (366-1095 and >1095) vs none, the risk for dementia was similarly elevated with the use of anticholinergics oxybutynin hydrochloride (adjusted odds ratios, 1.31, and 1.28), solifenacin succinate (1.18, and 1.29), and tolterodine tartrate (1.27 and 1.25).
Five other anticholinergics (darifenacin, fesoterodine fumarate, flavoxate hydrochloride, propiverine hydrochloride, and trospium chloride) were not significantly associated with elevated risk.
The risk for dementia was elevated by the use of mirabegron at total standardised daily doses of 91-365 and 366-1095 (adjusted odds ratios, 1.27 and 1.62), but not at higher or lower doses.

IN PRACTICE:

“[W]e found that of the different anticholinergic drugs used to treat an overactive bladder, oxybutynin hydrochloride, solifenacin succinate, and tolterodine tartrate, were most strongly associated with an increased of dementia in older adults,” the authors wrote. “This finding highlights the need for clinicians to take into account the possible long-term risks and consequences of the available treatment options for an overactive bladder in older adults, and to consider prescribing alternative treatments that might be associated with a lower risk for dementia,” they concluded.

SOURCE:

The study was led by Barbara Iyen, MBBS, PhD, MRCGP, University of Nottingham, Nottingham, UK, and was published online in BMJ Medicine.

LIMITATIONS:

Limitations included possible misclassification on dementia due to lack of recording or misdiagnosis, inability to assess over-the-counter treatments used, and possible selection of mirabegron for patients at higher risk for cognitive impairment.

DISCLOSURES:

The study was funded by the National Institute for Health and Care Research. One author disclosed receipt of grant funding from Novartis (manufacturer of darifenacin) for unrelated research.