INTRODUCTION: In 2021, the American Urogynecologic Society released an updated clinical consensus statement regarding the risk of cognitive impairment associated with anticholinergic medications. Despite the risks, anticholinergics remain the most common prescription for overactive bladder (OAB). OBJECTIVE: To analyze prescribing patterns of anticholinergic versus beta-3 agonist before and after release of the consensus statement. METHODS: This was a retrospective, national, database review utilizing the Medicare Part D Prescribers datasets for the years 2019–2023. We calculated the number of total 30-day fills for individuals over the age of 65 for all anticholinergics and beta-3 agonist medications. Our primary outcome assessed the difference in total prescriptions of beta-3 agonists versus anticholinergics in 2023 compared to 2019. Additionally, we reviewed prescribing patterns by physician type: family medicine, urology, and obstetrics and gynecology (OB/GYN). Appropriate statistical analysis was applied. RESULTS: When comparing OAB prescriptions from 2019 and 2023, there was a significant increase in the proportion of beta-3 agonist prescriptions, rising from 28% to 38%. Although oxybutynin remains the highest proportion of prescriptions, representing 4.29 million 30-day fills per year, there was a decrease from 55% to 45% from 2019 to 2023. The anticholinergics with less blood–brain barrier permeability, solifenacin and trospium, showed an increase in prescriptions over the 5-year time frame, while other anticholinergics decreased. When assessing prescribing rates by provider type in 2023, family medicine prescribed the highest proportion of anticholinergics versus beta-3 agonists, 72% versus 28%. While OB/GYN prescribed more beta-3 agonists than anticholinergics, 56% versus 44%. Despite the higher proportion of beta-3 agonist prescriptions, OB/GYNs only make up 7% of OAB prescriptions compared to 93% by family medicine and urology. CONCLUSIONS: There is a steady increase in prescriptions for OAB treatment with a rise in the proportion of beta-3 agonists. This rise is most pronounced in OB/GYNs who only make up a small portion of prescribing providers. While we are hopeful these trends demonstrate an increased knowledge of the risk of cognitive impairment with anticholinergic medications, oxybutynin continues to be the most prescribed medication despite this risk. These results are promising but show a continued need for education among primary care providers regarding the use of anticholinergics and highlight a need for continued advocacy for insurance coverage of beta-3 agonists.Figure 1Figure 2
Carrel-Lammert et al. (Fri,) studied this question.