International Continence Society (ICS) estimates that 12.8% of women and 10.8% of men suffer from OAB; the prevalence of frequency, urgency, and urge incontinence (UI) rises with age [1][2]. Behavioural and self-control training methods are regarded as first-line options for reducing urine incontinence in patients. Antimuscarinics or β3 adrenoceptor agonists are popular treatments for OAB if behavioural changes fail to alleviate symptoms [3]. In India, the most commonly prescribed OAB medications are solifenacin, oxybutynin, tolterodine, darifenacin, trospium, and mirabegron. The aim of this study is to assess the temporal prescription patterns of overactive bladder (OAB) pharmacotherapy especially antimuscarinic and beta-3 adrenoceptor agonists, based on the prescription trend analysis among Indian clinicians.

IQVIA (Quintiles and IMS Health) secondary sales audit (SSA) and prescription audit for antimuscarinics (solifenacin, oxybutynin, tolterodine, darifenacin, and trospium) and beta-3 adrenoceptor agonist (mirabegron) from 2014 to 2022, were analyzed. Prescribers overlap analysis for solifenacin and mirabegron among Indian urologists was also analyzed.

Urologists' prescription rates of OAB drugs were 65% in 2016 and 52% in 2022. The rate of OAB medication prescription by non-urologists was highest among surgeons (17%), followed by consultant physicians (9%) and gynecologists (8%) in 2022. In addition, among OAB medication prescription rates for antimuscarinics were 100% in 2016 and 56% in 2022 whereas for mirabegron, it was 0% in 2016 and 44% in 2022. The proportion of prescribers of OAB medication among urologists was 38% in 2016 and 33% in 2022. Exclusive prescribers of solifenacin were 748 in 2018 and 715 in 2022 at the urologist, whereas for mirabegron, it was 961 in 2018 and 1475 in 2022.

Urologists remained a top prescribing specialty for OAB drugs, although prescription share increased among surgeons and consultant physicians. OAB medication preferences by urologists are shifting from solifenacin to mirabegron. Other non-urologist specialties continue to prescribe antimuscarinics as a preferred drug for OAB. Antimuscarinics' prescription share shows a downtrend due to the risk of side effects and lowers therapy adherence compared with mirabegron, which is comparatively better tolerated & equally effective in OAB management.  Across Indian specialties, mirabegron emerges as a promising treatment option for overactive bladder. Recently approved fixed-dose combination of antimuscarinic, solifenacin, and beta-3 adrenoceptor agonist mirabegron is the newer approach for refractory OAB management in India.

The results of this study could further help clinicians, to design the optimum treatment approach in OAB patients according to their need, which can help to lower antimuscarinic side effects, improves treatment adherence, and improves patient’s QoL.

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