Evidence map›Paper›PMID 32638205›Full record

ArticleAdvances in therapy2020

Antimuscarinic Discontinuation in Patients with Overactive Bladder in Nursing Homes: A Retrospective Study of Medicare Beneficiaries.

Rajender R Aparasu, Sneha Sura, Jagadeswara R Earla, Aki Shiozawa, Daniel B Ng, Carol R Schermer

Open access · hybridAbstract read
In one paragraph

Article in Advances in therapy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact, top 87% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Rajender R AparasuDepartment of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, USA. rraparasu@uh.edu.
Sneha SuraDepartment of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, USA.
Jagadeswara R EarlaDepartment of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, USA.
Aki ShiozawaAstellas Pharma Global Development, Inc., Northbrook, IL, USA.
Daniel B NgAstellas Pharma Global Development, Inc., Northbrook, IL, USA.
Carol R SchermerAstellas Pharma Global Development, Inc., Northbrook, IL, USA.
Astellas Pharma (United States) · USUniversity of Houston · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAlthough antimuscarinics form the first-line therapy in overactive bladder (OAB), little is known regarding antimuscarinic discontinuation among OAB patients in nursing homes. This study examined treatment patterns and predictors of antimuscarinic discontinuation among long-term nursing home (LTNH) residents with OAB.

methodsThe study cohort included LTNH residents (defined as residents staying ≥ 101 consecutive days) from the Minimum Data Set linked 2013-2015 Medicare claims data. Patients with OAB were defined by OAB-related claims and medication codes. Treatment patterns and discontinuation (medication gap ≥ 30 days) were characterized by examining OAB-specific antimuscarinics prescribed during LTNH stays. The Andersen Behavioral Model was used to identify predisposing, enabling and need factors that predict discontinuation. Kaplan-Meier curves and multivariable Cox proportional hazards regression model were used to assess the unadjusted and adjusted times to discontinuation, respectively, among different antimuscarinics.

resultsThe mean age of the study cohort (n = 11,012) was 81.6 years (± 8.5), 74.6% were female, and 89.8% were non-Hispanic White. The mean duration of nursing home stay was 530.1 (± 268.4) days. The most commonly prescribed OAB-specific antimuscarinic was oxybutynin (69.8%). Overall, 66.5% of the study cohort discontinued the index antimuscarinic. Multivariable Cox PH regression analysis revealed that compared to LTNH residents who initiated treatment with oxybutynin, treatment discontinuation was lower with solifenacin or fesoterodin and discontinuation was more frequent when treatment was initiated with tolterodine, darifenacin or trospium compared with oxybutynin. In addition, several need factors (comorbidities, medication use and anticholinergic burden, etc.) were associated with antimuscarinic discontinuation.

conclusionAbout  two-thirds of LTNH residents with OAB discontinued their index antimuscarinic during their nursing home stay. There was significant variation in discontinuation based on the index antimuscarinic agent with lowest risk of discontiuation with solifenacin and fesoterodin. Concerted efforts to optimize antimuscarinic use are needed to improve the management of OAB in nursing homes.

Indexed as

AgedAged, 80 and overBenzofuransCohort StudiesFemaleHumansMaleMandelic AcidsMedicareMuscarinic AntagonistsNursing HomesProportional Hazards ModelsPyrrolidinesRetrospective StudiesUnited StatesUrinary Bladder, OveractiveBenzofuransMandelic AcidsMuscarinic AntagonistsPyrrolidinesUrological AgentsAdherenceAntimuscarinicNursing homeOveractive bladderUrology

Identifiers

PMID32638205
PMCPMC7370971
OpenAlexW3039541089

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.