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Jensen S, Walker D, Elsouda D, Lockefeer A, Kenton K, Peipert JD, Jackson KL, Helfand BT, Glaser AP, Cella D. An observational, patient-reported outcome study of sleep quality and depression among individuals with overactive bladder syndrome. Neurourol Urodyn 2024; 43:437-448. [PMID: 38108212 DOI: 10.1002/nau.25348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/06/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Overactive bladder (OAB) can adversely affect health-related quality-of-life (HRQoL) and adherence to treatments; however, the extent of their association is unknown. This study sought to characterize Sleep Disturbance, Depression, Fatigue, and patient-reported medication adherence among adults with OAB in the United States. MATERIALS AND METHODS: In this descriptive, observational study, patients completed patient-reported outcome (PRO) measures of urinary symptoms, anxiety, depression, fatigue, sleep quality, and medication adherence. PRO scores were compared across age, sex, body mass index, and sleep and antidepressant medication-taking subgroups. Exploratory analyses compared PRO scores between groups and estimated the effect size of differences. RESULTS Of 1013 patients contacted, 159 completed the assessments (female: 67.3%; ≥65 years of age: 53.5%; most severe OAB symptom: nocturia). Scale scores for Sleep Disturbance, Fatigue, and Depression were consistent with US population norms. No correlations of moderate or greater magnitude were observed between the severity of lower urinary tract symptoms and Sleep Disturbance, Fatigue, or Depression. When comparing individuals receiving antidepressants with those who were not, almost all outcomes including urinary symptoms, anxiety, and depression were significantly worse. Patients taking antidepressants also had poorer adherence to their OAB medications. CONCLUSION In this cohort of individuals with OAB, Sleep Disturbance, Fatigue, and Depression scores were in line with general population reference values; however, among the subgroups analyzed, patients on antidepressants had worse HRQoL and more substantial impacts on medication adherence, highlighting the importance of the assessment and management of depression in this population.
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Affiliation(s)
- Sally Jensen
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois, USA
| | - David Walker
- Astellas Pharma Global Development Inc., Northbrook, Illinois, USA
| | - Dina Elsouda
- Astellas Pharma Global Development Inc., Northbrook, Illinois, USA
| | - Amy Lockefeer
- Astellas Pharma Global Development Inc., Northbrook, Illinois, USA
| | | | - John Devin Peipert
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois, USA
| | - Kathryn L Jackson
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois, USA
| | | | | | - David Cella
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois, USA
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Lai HH, Walker D, Elsouda D, Lockefeer A, Gallington K, Bacci ED. Sleep Disturbance Among Adults With Overactive Bladder: A Cross-sectional Survey. Urology 2023; 179:23-31. [PMID: 37356462 DOI: 10.1016/j.urology.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To examine differences in sleep disturbance, nocturia, and depression among adults with overactive bladder (OAB) by treatment type. METHODS A cross-sectional survey of adults with OAB assessed sleep disturbance, nocturia, and depression using patient-reported outcome measures, including the Patient Reported Outcomes Measurement Information System (PROMIS)-29 Profile v2.1 (Sleep Disturbance and Depression domains), Lower Urinary Tract Dysfunction Research Network Symptom Index-10, and PROMIS Sleep Disturbance Short Form 8B. Treatment groups included antimuscarinics, β-3 adrenergic agonists, and no treatment. Analysis of covariance (ANCOVA) was used to test for differences in study endpoints; Bonferroni-adjusted pairwise tests (P < .05/3) were performed to compare differences in least squares means between groups. RESULTS One hundred participants were included per treatment group. The overall mean (standard deviation) age across all groups was 47.8 (11.8) years. Symptom scores across all PROMIS domains in all three treatment groups were higher than the US general population. There were no statistically significant differences in outcomes across treatment groups. CONCLUSION Adults with OAB reported being affected by sleep disturbance and depression, regardless of treatment. The mirabegron group trended toward the lowest symptom impact across all outcomes, however, comparisons were not significant. Future research should examine temporal associations between OAB treatment, sleep disturbance, and outcomes.
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Affiliation(s)
- H H Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - D Walker
- Astellas Global Pharma Development, Inc., Northbrook, IL.
| | - D Elsouda
- Astellas Global Pharma Development, Inc., Northbrook, IL
| | - A Lockefeer
- Astellas Global Pharma Development, Inc., Northbrook, IL
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Cooperberg MR, Mbassa R, Walker D, Meeks W, Lockefeer A, Jiang B, Li T, Johnston K, Fang R. Insights from the AQUA Registry: a retrospective study of anticholinergic polypharmacy in the United States. Ther Adv Urol 2023; 15:17562872221150572. [PMID: 36703880 PMCID: PMC9871979 DOI: 10.1177/17562872221150572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/24/2022] [Indexed: 01/22/2023] Open
Abstract
Background Anticholinergic (ACH) burden is a risk factor for negative health outcomes among older adults. Several medications contribute to ACH burden, including antimuscarinics used to manage overactive bladder (OAB). Objectives This study aimed to understand the extent of ACH burden in an OAB population in the United States. Design Non-interventional retrospective analysis. Methods Adults with OAB whose care providers participated in the American Urological Association Quality (AQUA) Registry between 2014 and 2020 were included in this study. An adapted version of the Pharmacy Quality Alliance (PQA) measure of anticholinergic polypharmacy (poly-ACH) was used to assess ACH burden. The primary outcome was the annual prevalence of poly-ACH, and a secondary outcome was the percentage of patients taking 0, 1, 2, 3, 4, or ⩾ 5 ACH medications by calendar year. Analyses were stratified by age category at diagnosis and sex. Results The sample comprised 552,840 patients with OAB. The mean age at initial OAB diagnosis was 65.7 years (58.2% male; 57.4% white). Prevalence of poly-ACH was highest in 2015 (3.7%) and lowest in 2020 (1.9%). Patients prescribed no ACH medications made up the largest proportion of each cohort, while those prescribed five or more comprised the smallest. The trend of decreasing proportions of patients taking increasing numbers of ACH medications was consistent. The proportion of patients prescribed no ACH medications increased from 63.3% in 2014 to 74.6% in 2020. The percentage of those prescribed three or more ACHs remained largely unchanged. Poly-ACH was highest among younger individuals (< 65 years of age) and females; temporal trends were similar overall and within each age and sex stratum. Conclusion In this study, poly-ACH in patients with OAB was relatively infrequent and decreased over the study period. Further evaluation of poly-ACH is needed to assess whether the study findings reflect increased awareness of the negative effects of poly-ACH.
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Affiliation(s)
- Matthew R. Cooperberg
- Departments of Urology and Epidemiology &
Biostatistics, University of California, San Francisco, CA, USA
- American Urological Association, Linthicum, MD,
USA
| | | | | | | | - Amy Lockefeer
- Astellas Pharma Global Development Inc.,
Northbrook, IL, USA
| | | | - Tina Li
- Broadstreet Health Economics and Outcomes
Research, Vancouver, BC, Canada
| | - Karissa Johnston
- Broadstreet Health Economics and Outcomes
Research, Vancouver, BC, Canada
| | - Raymond Fang
- American Urological Association, Linthicum,
MD, USA
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Johnson TM, Walker D, Lockefeer A, Jiang B, Nimke D, Lozano‐Ortega G, Kimura T. Mirabegron and antimuscarinic use in frail overactive bladder patients in the United States Medicare population. Neurourol Urodyn 2022; 41:1872-1889. [PMID: 36098417 PMCID: PMC9826123 DOI: 10.1002/nau.25040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Overactive bladder (OAB) and frailty are independently associated with patient burden. However, economic burden and treatment-taking behavior have not been well characterized among frail patients with OAB, which, given the varying safety and tolerability profiles of available treatments, is crucial. OBJECTIVES To assess costs, health care resource utilization, treatment-taking behavior (persistence and adherence) to OAB medication in older, frail OAB patients. METHODS This was a retrospective cohort study using international business machines MarketScan Medicare Supplemental claims data. Eligible frail patients (per Claims-based Frailty Index score) initiating mirabegron were 1:2 propensity score matched (based on age, sex, and other characteristics) with those initiating antimuscarinics and were followed up to 1 year. All-cause, per-person, per-month costs, health care encounters, persistence (median days to discontinuation assessed using Kaplan-Meier methods) and adherence (≥80% of proportion of days covered at Day 365) were compared. RESULTS From 2527 patients with incident mirabegron (21%) or antimuscarinic (79%) dispensations, 516 incident mirabegron users (median age: 82 years, 64% female) were matched to 1032 incident antimuscarinic users (median age: 81 years, 62% female). Median cost was higher in mirabegron group ($1581 vs. $1197 per month); this was primarily driven by medication cost. There was no difference in medical encounters. Adherence (39.1% vs. 33.8%) and persistence (103 vs. 90 days) were higher in mirabegron users. CONCLUSIONS Among frail older adults with OAB, mirabegron use was associated with higher costs and potential improvements in treatment-taking behaviors, particularly with respect to treatment adherence, versus those initiating antimuscarinics.
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Affiliation(s)
| | - David Walker
- Astellas Pharma Global Development Inc.NorthbrookIllinoisUSA
| | - Amy Lockefeer
- Astellas Pharma Global Development Inc.NorthbrookIllinoisUSA
| | | | - David Nimke
- Astellas Pharma US Inc.NorthbrookIllinoisUSA
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Kraus SR, Li J, Kristy RM, Lockefeer A, Yang H, Zhou M, Walker DR. Evaluating and understanding combination therapy decision drivers for the treatment of overactive bladder in the United States. J Int Med Res 2022; 50:3000605221098176. [PMID: 35588263 PMCID: PMC9127871 DOI: 10.1177/03000605221098176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To understand factors guiding overactive bladder (OAB) therapy selection and experience with combination therapy (antimuscarinics and beta-3 agonists). METHODS Cross-sectional surveys of OAB patients and OAB-treating physicians in the USA were conducted. Patients receiving monotherapy with antimuscarinics were categorized by OAB treatment history: monotherapy only; third-line procedures (e.g., onabotulinumtoxinA injections) and combination therapy; third-line therapy only; and combination therapy only. The patient survey assessed therapy choice drivers and barriers, treatment satisfaction and sociodemographic/clinical characteristics. The physician survey assessed drivers of and barriers to OAB treatment choices. RESULTS Of 200 patients, 86.5% reported involvement in treatment decision-making; doctor's recommendation was the most frequently considered factor (84.4%). Most patients (71%) were unaware of combination therapy. The primary reason why those patients aware of combination therapy had not used it (N = 43/200; 21%) was physician recommendation of other treatments (69.8%). For physicians (N = 50), the most frequently considered factors when prescribing OAB treatment were effectiveness (92.0%) and side effects (84.0%); 70% prescribed combination therapy, primarily for symptom severity (82.9%). The main reasons for not prescribing combination therapy were cost/insurance coverage (80%) and lack of information (53.3%). CONCLUSIONS Shared decision-making guided treatment decisions; the main considerations were treatment safety and efficacy.
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Affiliation(s)
- Stephen R Kraus
- University of Texas Health Sciences Center, San Antonio, TX, USA
| | | | - Rita M Kristy
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | - Amy Lockefeer
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - Mo Zhou
- Analysis Group, Inc., Boston, MA, USA
| | - David R Walker
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
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Campbell NL, Hines L, Epstein AJ, Walker D, Lockefeer A, Shiozawa A. A 12-Year Retrospective Study of the Prevalence of Anticholinergic Polypharmacy and Associated Outcomes Among Medicare Patients with Overactive Bladder in the USA. Drugs Aging 2021; 38:1075-1085. [PMID: 34746992 PMCID: PMC8651576 DOI: 10.1007/s40266-021-00901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/24/2022]
Abstract
Background and Objective Antimuscarinics, drugs with anticholinergic properties, are frequently prescribed for overactive bladder, and anticholinergic burden is associated with adverse events. The “Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults” (Poly-ACH) measure was developed by the Pharmacy Quality Alliance and is used by the Centers for Medicare and Medicaid Services. Using the Poly-ACH measure, we assessed the prevalence of anticholinergic polypharmacy among Medicare patients in the USA with overactive bladder and determined associations between polypharmacy and medical conditions, care, and spending. Methods This was a retrospective cohort study of Medicare beneficiaries with overactive bladder (coverage period: 2006–2017). Anticholinergic polypharmacy, measured by the Poly-ACH, was defined as concurrent use of two or more anticholinergics, each with two or more prescription claims on different dates of service for ≥ 30 cumulative days. Change in annual frequency of anticholinergic polypharmacy was assessed using logistic regression. Associations between anticholinergic polypharmacy over 3 years and falls, fractures, mental status, and medical care spending were assessed with longitudinal regression models. Results In total, 226,712 patients contributed 940,201 person-years of follow-up after overactive bladder diagnosis. The share of patients meeting the Poly-ACH definition was 3.3% in 2006 and 1.7% in 2017. Women and nursing home residents had higher risks of anticholinergic polypharmacy. Having 1 year or more of positive Poly-ACH status in the 3 years prior was associated with higher rates of all outcomes. Conclusions Anticholinergic polypharmacy was uncommon among older adults with overactive bladder. Prevalence was higher among women and nursing home residents, and it was associated with negative outcomes, highlighting potential longitudinal implications of anticholinergic burden. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00901-2.
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Affiliation(s)
- Noll L Campbell
- Purdue University College of Pharmacy, West Lafayette, IN, USA.,Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Lisa Hines
- Pharmacy Quality Alliance, Alexandria, VA, USA
| | | | - David Walker
- Medical Affairs, U.S., Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA
| | - Amy Lockefeer
- Medical Affairs, U.S., Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA
| | - Aki Shiozawa
- Medical Affairs, U.S., Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA.
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