There are two major classes of oral therapy: anticholinergic (ACH) and beta-3 agonist (β3) medications. While ACH medications are effective, there are many bothersome side effects that diminish compliance. Also, there is growing evidence of harmful long-term cognitive side effects, particularly in elderly or frail patients. β3 medications, introduced in 2012, are effective alternatives to ACH medications with fewer harmful or intolerable side effects.
We conducted a cross-sectional study analyzing the American Urological Association Quality (AQUA) Registry. The AQUA registry is a National Qualified Clinical Data Registry developed by urologists in 2014 for measuring and reporting quality of care and performing health service and outcome research. Our primary outcome was to determine which factors were associated with an increased odds ratio (OR) of receiving a β3 as first line medication choice for treatment of OAB. We queried the AQUA database from 2014 to 2020 for adult patients with a diagnosis of OAB with at least 1 year of data.
We found that patient groups more likely to receive a β3 compared to others included patients with private or military insurance, of white race, receiving care outside of a metropolitan area or academic setting, of increasing age above 50, and those receiving a prescription in each subsequent year after 2014. There was no difference between genders. These differences in choice of first medication for OAB may point to evidence of disparity among how different groups of patients are treated for this prevalent condition, particularly based on insurance type and race. The AQUA database is particularly useful for this research because it is less homogenous than other comparable datasets and designed to be more representative of the overall population. We have demonstrated the ability to utilize the AQUA data to draw novel and meaningful conclusions regarding medical treatment of OAB. The conclusions presented here shed light on prescription choices for treating OAB among urologists in the United States and may prove useful for addressing disparate prescription patterns among different groups of patients.
Written by:
- Max Bowman, MD, Department of Urology, University of California San Francisco, San Francisco, CA
- Dora Jericevic, MD, Department of Urology, New York University Langone, New York, NY.
- Benjamin M Brucker, MD, Department of Urology, New York University Langone, New York, NY.
- Michelle Van Kuiken, MD, Department of Urology, University of California San Francisco, San Francisco, CA.