NEW ORLEANS, LA USA (UroToday.com) - Overactive bladder (OAB) remains a major problem afflicting millions of patients in the United States and worldwide.
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This symposium, chaired by Karl-Erik Andersson, MD., PhD. and Alan J. Wein, MD. addressed important aspects of the condition of voiding dysfunction and reviewing the past 15 years of treatment for overactive bladder syndrome. Dr. Alan Wein opened the symposium by introducing the goals and objectives of the session. There were several topics included in the presentations in this review, including the origin to the nomenclature of the term overactive bladder, the symptoms that are a part of the condition, treatment options, cost effectiveness, and currently published trials.
Paul Abrams, MD. discussed the origin of the term overactive bladder (OAB) and provided the historic perspective on the symptom syndrome of OAB. Jerry Blaivas, MD. continued the discussion with a critical look at the definitions of the symptoms for OAB, which we define today as the hallmark symptom of urgency with frequency with or without urinary incontinence.
Sender Herschorn, MD, FRCSC, University of Toronto, opened his presentation concerning OAB and its impact on quality of life by referencing the EpiiLUTS survey. He emphasized that this was a large US-based survey including both men and women. He reported the survey showed that over 60% of men and women are bothered by the symptom syndrome of OAB. Worse sexual function was associated with OAB, noting diminished sexual activity and enjoyment and was a predictor of erectile dysfunction. Another area he highlighted from the study was the impact of OAB on work productivity, stating that OAB cases were more likely to be unemployed or impaired while working. Men with OAB were 1.5 times more likely to be unemployed than those with none or nominal symptoms. Work impairment was comparable to persons with rheumatoid arthritis and asthma. Economic costs associated with OAB are rising and are 5 times higher than older estimates in early 2000. He went on to review all the antimuscarinic clinical trials including the two Cochrane collaborative reviews. He also provided treatment rates from the IMS health data set of over 7 million patients greater or equal to 45 years of age diagnosed with OAB. Only 24.4% were treated, leaving 75.6% untreated. Only 25.6% of those treated were men in a condition where men and women have similar prevalence. Dr. Herschorn went on to discuss systematic review of persistence and adherence. After reviewing 147 articles of 12 week trials looking at antimuscarinic treatment discontinuation rates they ranged from 4 - 31% in the treatment groups and 5 - 20% in the placebo arms. In 14 medical claims studies discontinuation rates at 30 days was 43 - 83% and rose over time. Over half never refilled a prescription. He made a point of emphasizing that persistence rates are higher with many other medications for instance at 56% for statins, 66% for oral diabetic drugs, 47% for prostaglandins and 56% for bisphosphonates. And patient factors play a major role in one small study of 33 women with OAB who were interviewed in focus groups, reported being dissatisfied with care received and having unrealistic treatment expectations. OAB appears to have its greatest impact on costs and absenteeism. Dr. Herschorn presented the results from a 2001 - 2011 claims database of 27 large US employers of 1.5 MM employees, 2960 were prescribed OAB drugs and only 12.8% adhered to prescription treatment. Lower adherence increased co-pay and co-pay as a percentage of salary. Higher adherence to the OAB medications resulted in lower medical, sick leave and short term disability costs, but higher drug costs. There are multiple reasons for discrepancies in pharmaceutical reporting of clinical trial data and real world patient care. OAB remains highly prevalent, costly and has a significant impact on society.
Victor Nitti, MD., listed the key known facts about pharmacologic treatments for overactive bladder (OAB). Anticholinergics have been first-line pharmacotherapy treatment for the past 30 years. They are more effective than placebo for mean/median change in urge urinary incontinence (UUI) episodes and micturitions per day. Most studies evaluating urgency show active treatments to be more effective than placebo. Agents with multiple doses are more effective than single dose drugs in some comparator trials. Antimuscarinic agents are statistically significantly associated with greater risk of adverse events. None have been shown to be associated with serious adverse events. The conundrum is that not all patients respond adequately to treatment. Some patients experience intolerable side-effects. For many patients the efficacy/side-effect ratio is simply not enough to continue. Dr. Nitti then reviewed the new class of agents, beta3 agonists, mirabegron. He demonstrated an improved side effect profile and the opportunity to treat more patience with mirabegron alone or in combination with antimuscarinics. We are looking forward to the late breaking abstract being presented at this meeting entitled, "Efficacy and Safety of Mirabegron add on treatment to Solifenacin in Incontinent OAB subjects with an Inadequate Response to Initial 4-week Solifenacin Monotherapy."
The symposium ended with Karl-Erik Andersson, MD, PhD. providing a look into the future of potential new agents that will hopefully offer patients additional efficacious and safe treatment options.
Presented at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Reported by Zhamshid Okhunov, MD (University of California-Irvine), medical writer for UroToday.com
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