title: Limitations of anticholinergic cycling in patients with overactive bladder (OAB) with urinary incontinence (UI): results from the CONsequences of Treatment Refractory Overactive bLadder (CONTROL) study.
abstract: OBJECTIVE
  To describe treatment patterns and outcomes in wet-overactive bladder (OAB) patients treated with anticholinergics.
  
  
  METHODS
  This study was a retrospective claims analysis linked to a one-time patient survey of members of a regional medical group located in California. Participants met the following criteria: received anticholinergic therapy between January 2008 and May 2012, based on pharmacy claims; had a diagnosis of OAB; and reported having ≥1 urinary incontinence (UI) episode per day at the time of the survey. Outcomes included the number of anticholinergics cycled through from treatment initiation until the end of follow-up (May 31, 2013); frequency of UI episodes; and patient requests for additional help for their OAB symptoms.
  
  
  RESULTS
  A total of 620 patients were enrolled into the study. During the follow-up period, patients cycled through 1 to 6 unique anticholinergics; 65 % of the study population used only 1 anticholinergic, while 35 % used ≥2 anticholinergics. Patients reported experiencing an average of 3.5 UI episodes per day (3.6, 3.3, and 3.4 episodes for 1, 2, and ≥3 anticholinergics used, respectively), and over 80 % of patients requested additional help for their OAB symptoms, irrespective of how many anticholinergics were attempted.
  
  
  CONCLUSIONS
  UI symptom burden and adherence to therapy did not change as patients attempted more anticholinergic therapies. These results suggest that for patients who remain incontinent after attempting an anticholinergic, cycling on additional anticholinergics may not provide any additional benefit, resulting in sub-optimal care.
authors.affiliation: Beaumont Health System, Beaumont Hospital, Royal Oak, MI, USA. chancellormb@gmail.com.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Chancellor
authors.affiliation: Allergan, Inc., Irvine, CA, USA.
authors.forename: Alon
authors.initials: A
authors.lastname: Yehoshua
authors.affiliation: Medtronic, Inc., Minneapolis, MN, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Waweru
authors.affiliation: Novartis, Inc., East Hanover, NJ, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Globe
authors.affiliation: Roche Molecular Systems, Inc., Pleasanton, CA, USA.
authors.forename: I-Ning
authors.initials: IN
authors.lastname: Cheng
authors.affiliation: Allergan, Inc., Irvine, CA, USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Campbell
authors.affiliation: Allergan, Inc., Irvine, CA, USA.
authors.forename: Manher
authors.initials: M
authors.lastname: Joshi
authors.affiliation: HealthCare Partners, Torrance, CA, USA.
authors.forename: Riya
authors.initials: R
authors.lastname: Pulicharam
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000188:drug therapy*; D014563:Urodynamics; D016903:Drug Monitoring
chemical_list: D018680:Cholinergic Antagonists
keywords: Anticholinergics; Limitations; Overactive bladder; Urinary incontinence