Most Patients With OAB Report Symptom Improvement at Nearly 3 Years

Only about one quarter of patients with overactive bladder (OAB) were currently taking their initial oral regimen after nearly 3 years, yet most reported symptom improvement, according to a prospective, nonrandomized cohort study in Clinics and Practice.¹

Investigators from Nicolaus Copernicus University in Torun, Poland, followed 106 adults with specialist-confirmed OAB. Patients were initially managed in routine outpatient urology care with solifenacin 5 mg (Vesicare; Astellas Pharma; n = 53), solifenacin 10 mg (n = 30), or mirabegron 50 mg (Myrbetriq; Astellas Pharma; n = 23). Treatment was prescribed in routine care rather than assigned by the study team.

Telephone interviews were completed by 83 participants after a mean of 32.6 months (range, 29.8-35.3). Seven respondents were excluded because of concerns about the reliability of their reported histories, leaving 76 participants with linked data. Those 76 represented 71.7% of the baseline cohort. Of these, 75 had a current Overactive Bladder Symptom Score (OABSS).

Treatment Pathways at Follow-Up

At follow-up, 20 of 76 participants (26.3%) were receiving their index oral regimen. Another 22 (28.9%) were taking a different oral monotherapy, 17 (22.4%) were receiving no treatment, 16 (21.1%) were receiving nonoral or other urological management, and 1 (1.3%) was receiving combination oral therapy. The category included interventions for associated lower urinary tract conditions and was not equated with escalation for refractory OAB. Two participants reported intradetrusor botulinum toxin, and 3 reported sacral neuromodulation.

Among the 22 patients on a different oral monotherapy, 8 were taking solifenacin 10 mg after starting at 5 mg, 2 were taking 5 mg after starting at 10 mg, 7 were taking mirabegron after starting solifenacin, and 5 were taking solifenacin after starting mirabegron.

Median current OABSS was 3 (IQR, 2-6.5), and mean scores were 2.36 points lower than at baseline off treatment (95% CI, −3.55 to −1.17; lower scores indicate fewer symptoms). A reduction of at least 3 points occurred in 41 of 75 participants (54.7%).

Global patient-reported measures were more favorable. A total of 65 of 76 participants (85.5%) described their bladder condition as improved, including 50 (65.8%) who said it was much or very much better. Sixty-seven (88.2%) reported that treatment had definitely or probably helped, and 60 (78.9%) reported no, very minor, or minor current bladder-related bother. The authors noted these questions were study-specific and not validated quality-of-life instruments.

Discontinuation Did Not Always Signal Failure

Among the 17 untreated participants, symptom improvement was the most common principal reason for earlier discontinuation or modification, cited by 8 (47.1%). Three each cited insufficient benefit from the outset or adverse effects or complications, 2 cited loss of an initially beneficial effect, and 1 cited reluctance to continue long-term medication. Across 50 of 76 participants who gave a reason for any treatment change, loss of an initially beneficial effect and adverse effects or complications were each cited by 13 (26.0%), and symptom improvement by 10 (20.0%).

“At long-term follow-up, most patients reported sustained symptomatic improvement, often sufficient to permit discontinuation; discontinuation therefore did not uniformly indicate treatment failure,” the authors wrote.

A 2010 US survey of 1322 respondents who had stopped antimuscarinics in the prior 12 months, latent class analysis grouped 89% by unmet treatment expectations, tolerability, or both, and 11% by a general aversion to taking medication.² The Polish authors said that their findings support discussing why treatment changed rather than treating discontinuation uniformly as failure.¹

Dry Mouth Linked to Antimuscarinic Use

Xerostomia was reported by 32 of 76 participants (42.1%). It occurred in 21 of 32 current antimuscarinic users compared with 11 of 44 nonusers (OR, 5.73; 95% CI, 2.11-15.55). The association persisted after adjustment for age, sex, body mass index, and polypharmacy (adjusted OR, 8.66; 95% CI, 2.67-28.08). Because exposure and symptoms were measured at the same interview, the findings describe association rather than causation.

The study was single-center, nonrandomized, and drew from a clinic-based cohort. Participants with linked data were more often male than those without (48.7% vs 26.7%), which the authors said suggests potential attrition and selection bias. Treatment history relied on patient recall, and current medication use was not independently verified.

Current OABSS did not differ significantly by initial treatment group, but the authors cautioned that this does not establish equal efficacy of the original medications. Subgroups were small, and many participants had changed regimens before follow-up.

The investigators said the findings support repeated reassessment of symptoms, perceived benefit, reasons for treatment change, and tolerability. They called for multicenter prospective studies with repeated symptom assessments, contemporaneous documentation of treatment changes, and independently verified medication exposure.

References

1. Ostrowski A, Ostrowska M, Kowalski F, et al. Treatment trajectories and symptom burden in overactive bladder: long-term follow-up of a prospective, nonrandomized cohort. Clin Pract. 2026;16(11):199. doi:10.3390/clinpract16110199

2. Benner JS, Nichol MB, Rovner ES, et al. Patient-reported reasons for discontinuing overactive bladder medication. BJU Int. 2010;105(9):1276-1282. doi:10.1111/j.1464-410X.2009.09036.x