title: Treatment with rivastigmine or galantamine and risk of urinary incontinence: results from a Dutch database study.
abstract: BACKGROUND
  Treatment of Alzheimer disease (AD) with cholinesterase inhibitors (ChEIs) may increase the risk of urinary incontinence (UI).
  
  
  OBJECTIVE
  To assess whether ChEI use was associated with the risk of UI among older patients with AD.
  
  
  METHODS
  A crossover cohort study using the PHARMO Record Linkage System included 10 years of data on drug dispensing histories for over two million Dutch residents. Included patients were aged 50 +, free of UI for the last 6 months, received a first ChEI prescription during the study period, had at least 12 months prior drug exposure history and one subsequent prescription of any drug. UI was defined as a first dispensing of a urinary spasmolytic or of incontinence products for at least 30 days. Cox regression with time-varying covariates and multivariate adjustment allowed assessing whether UI incidence was associated with ChEI exposure.
  
  
  RESULTS
  Among 3154 patients there were 657 UI cases during a mean follow-up of 5.1 years before a first ChEI dispensing, and 499 cases after ChEI initiation, during a mean follow-up of 2.0 years. Among the 2700 participants free of UI one year before ChEI initiation, the adjusted hazard ratio (HR) for UI was 1.13 (95% CI: 0.97-1.32) when periods with ChEI use were compared to periods without ChEI use. Sensitivity analyses may suggest an increased risk in the 1(st) month after ChEI initiation (HR: 1.72, p = 0.09) CONCLUSION: Worsening AD may increase incidence of UI, but no firm association between ChEI treatment and risk of UI could be shown from these data.
authors: Centre d'excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec, Québec, Canada; Utrecht University, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, the Netherlands.
authors: Edeltraut
authors: E
authors: Kröger
authors: Rob
authors: R
authors: Van Marum
authors: Patrick
authors: P
authors: Souverein
authors: Pierre-Hugues
authors: PH
authors: Carmichael
authors: Toine
authors: T
authors: Egberts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy / Q000453:epidemiology; D002800:Cholinesterase Inhibitors / Q000009:adverse effects*; D015331:Cohort Studies; D018592:Cross-Over Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005702:Galantamine / Q000009:adverse effects*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D000068836:Rivastigmine / Q000009:adverse effects*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000139:chemically induced* / Q000453:epidemiology*
chemical_list: D002800:Cholinesterase Inhibitors; D005702:Galantamine; D000068836:Rivastigmine
keywords: Alzheimer disease; cholinesterase inhibitors; database cohort study; pharmacoepidemiology; urinary incontinence