Anticholinergic cycling not effective in OAB with UI

Royal Oak, MI-The adage, “If at first you don’t succeed, try, try again,” does not appear to hold true when it comes to anticholinergic drug use in overactive bladder patients with urinary incontinence, recent study results indicate.

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With several anticholinergic agents available to treat OAB patients with urinary incontinence, opinions vary as to how many should be tried, first author Michael Chancellor, MD, explained to Urology Times. 

To evaluate anticholinergic cycling, Dr. Chancellor and colleagues conducted a retrospective claims analysis linked to a patient survey administered to OAB patients from a California-based accountable care organization (ACO). Patients had at least one diagnosis of OAB and at least one urinary incontinence episode per day and initiated anticholinergic therapy between January 2008 and May 2012. Anticholinergic cycling was defined as moving from one unique anticholinergic to another.

The authors found that patient discontinuation of anticholinergic agents was high, with 467 of the 655 patients stopping use of the medication. The majority of patients tried one anticholinergic (426), 176 tried two agents, 39 tried three, and 14 tried four or more, reported Dr. Chancellor, professor of urology and director of neurourology at Beaumont Health System, Oakland University William Beaumont School of Medicine, Royal Oak, MI. One patient tried six agents, and failed all six.

The authors found that the number of urinary incontinence episodes per day was similar regardless of the number of anticholinergics attempted and regardless of whether patients continued or discontinued therapy. In addition, most patients were still bothered by bladder symptoms regardless of whether they continued or discontinued therapy.

Next: Findings a 'game changer'

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Findings a ‘game changer’

Dr. Chancellor, who presented the findings at the AUA annual meeting in Orlando, FL, called the findings “surprising” and “a game changer.”

Dr. Chancellor“A year or two ago, I was in the camp of trying at least two or three. And seeing this, and talking to the ACO, we realized we were really not doing any benefit except making [patients] try multiple pills and perhaps wasting 6 months of everybody’s time,” Dr. Chancellor said.

In fact, as a consequence of the findings, Dr. Chancellor said the ACO revised its clinical pathway to stop anticholinergic use after failure with two agents. Dr. Chancellor told Urology Times that he himself stops prescribing anticholinergics after failure of a single agent in most cases.

“The take-home message is taking multiple anticholinergics does not improve resolution of incontinence; patients are not happy, so it’s time to get off the anticholinergic cycling wagon,” Dr. Chancellor said.

The study was sponsored by Allergan, for whom Dr. Chancellor is a consultant and speaker.

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