SAN DIEGO—Urologists and gynecologists are more likely than primary care doctors to prescribe second-generation agents as initial treatment for overactive bladder (OAB), according to a study presented at the American Urological Association’s 2016 annual meeting.
The study, which included 17,944 Medicare beneficiaries with OAB, examined trends in the initial pharmacotherapy for OAB. It found that black patients were significantly less likely than white patients to be prescribed second-generation OAB drugs (darifenacin, fesoterodine, mirabegron, solifenacin, and trospium). The study also documented annual increases in the use of these drugs.
Urologists and gynecologists were 49% and 30% more likely than primary care doctors to prescribe second-generation OAB drugs, researchers led by Charles D. Scales, Jr., MD, of Duke University Medical Center in Durham, NC, reported. Blacks were 9% less likely than whites to be prescribed second-generation OAB drugs.
Compared with physicians in 2007, physicians in 2010, 2011, 2012, and 2013 were 9%, 13%, 18%, and 27% more likely to prescribe second-generation drugs as initial OAB treatment.
Patients with dementia were 13% more likely to be prescribed a second-generation OAB drug than those without dementia, a finding that Dr Scales said is encouraging because limited evidence suggests that certain newer agents may be less likely to worsen dementia.
“The main finding of our study was that specialists were more likely to prescribe newer, more expensive drugs as the first medication to treat overactive bladder symptoms, Dr Scales told Renal & Urology News. “This finding is important because current guidelines suggest that older and newer extended-release agents are equally effective in treating patient symptoms. Doctors and patients should remember that newer is not automatically better, so when starting medication for overactive bladder symptoms, the benefits, side effects, and costs should be carefully considered.”
Other studies have shown that medication costs can be burdensome for older adults, and some patients have to make a choice about which medicine they are going to take, he noted.
“In our study, patient costs for the newer drugs were on average 5 times higher than for the older drugs,” Dr Scales said. “Doctors should aim for high value prescribing, which means that when 2 medications work equally well, the lower cost medication is preferred.”