This study aims to determine the persistence rate of Vibegron, β3-adrenoceptor agonist, and the reasons for its discontinuation in patients over 80 with Overactive Bladder (OAB). It has been reported that OAB patients have a 1.61 times higher risk of developing dementia and a 2.78 times greater risk of becoming frail compared to those without OAB. As the prevalence of chronic diseases and the number of regular medications typically increase with age. Among patients over the age of 65 who are prescribed medications, it is estimated that half are taking at least one medication with anticholinergic properties. The Anticholinergic Cognitive Burden (ACB) score, which quantifies the anticholinergic load of medications, suggests that a total ACB score of 3 or above for all medications regularly taken by a patient may be associated with an increased risk of cognitive impairment. Furthermore, Reports indicate that patients consuming 6 or more medications frequently encounter a rise in adverse effects. This underscores the imperative for meticulous management of side effects and the maintenance of consistent treatment regimens to avert the progression to states of frailty and cognitive deterioration.

In this retrospective cohort study, 844 OAB patients aged 80 and above who began Vibegron treatment from November 2018 to October 2023 at the urology outpatient clinics of nine hospitals were examined. Patients were excluded if they were under 80 at the initiation of treatment, had an unclear medication history, received prescriptions from non-urology departments, or did not have follow-up. Data were collected on age, gender, medical history, concurrent medications, and reasons for discontinuation of Vibegron, categorized as symptomatic improvement, insufficient efficacy, adverse events, self-discontinuation, death, and other factors. Patients were classified based on their ACB score (0, 1-2,  ≥3), with propensity score matching employed to adjust for intergroup differences. In an additional subgroup analysis, patients were categorized by their number of concurrent medications (0, from 1-5,  ≥6). Upon attempting to perform propensity score matching for groups divided by the number of regular medications, it was found that all groups were classified into the category of ≥6 medications. Therefore, propensity score matching was not conducted for these groups.

Patients were divided into groups based on ACB scores (Table1), following the propensity score matching, the number of patients in each group was as follows: 390 patients with a score of 0, 282 patients with scores ranging 1-2, and 172 patients with scores of  ≥3 . Patients were divided into groups based on medication count revealed that there were 59 patients with no other medications, 525 patients with 1-5 medications, and 260 patients with ≥6 medications (Table2). There was a significant decrease in the continuation of Vibegron treatment as ACB scores increased (P=0.0145)(Figure 1A). The increase in the number of medications was also associated with a significant reduction in therapy continuation (P=0.0271)(Figure 2B). No significant differences were observed in the  six reasons  (symptomatic improvement, insufficient efficacy, adverse events, self-discontinuation, death, and other factors) for discontinuation across all groups in the analyses of both ACB scores and the number of medications.

This study demonstrates that elderly patients with OAB who have higher ACB scores or are taking multiple medications are less likely to continue with Vibegron treatment. The findings suggest that an increase in the number of regular medications is associated with a decrease in medication adherence. Furthermore, the study implies that cognitive decline due to increased ACB scores may also contribute to the reduction in medication adherence.

Managing OAB in the elderly is a multifaceted challenge that extends beyond symptom control, necessitating a prevention-focused approach to cognitive and physical health. Personalized Vibegron treatment, attentive to both efficacy and adverse effects, is paramount to ensure a higher quality of life for this vulnerable patient group. It is essential not only to achieve therapeutic effectiveness but also to maintain a high rate of treatment continuation, as this is crucial for long-term management success and patient well-being.

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Yoshida M, et al. A non-interventional cross-sectional re-contact study investigating the relationship between overactive bladder and frailty in older adults in Japan.. BMC Geriatr, 2022. 22(1): p. 68.
Kojima T, et al. High risk of adverse drug reactions in elderly patients taking six or more drugs: analysis of inpatient database. Geriatr Gerontol Int, 2012. 12(4): p. 1761–23.

Continence 12S (2024) 101558
DOI: 10.1016/j.cont.2024.101558