Is there an increased risk of delirium among patients with overactive bladder treated with newer anticholinergic medication compared to a beta-3 agonist?
Abstract
ABSTRACT
Objective
To determine if there is an increased risk of delirium among patients with overactive bladder (OAB) started on anticholinergic medication compared to beta-3 agonist.
Methods
We conducted a population-based, retrospective, matched weight cohort study using administrative data from Ontario, Canada from January 2016 until March 2020. We matched 13865 new users of Oxybutynin to 33097 new users of newer anticholinergic medications (Solifenacin, Tolterodine, Trospium, Darifenacin and Fesoterodine), and to 56062 new users of beta-3 agonist medication (Mirabegron); all of the included medications are only for the treatment of OAB. Matching weights (an extension of the propensity score weighting) were used to balance the three exposure groups based on 83 measured indicators of baseline health, comorbidity, medication usage and health care utilization. The primary exposure was the class of OAB medication (Oxybutynin, Newer anticholinergics, and Beta-3 agonist). The primary outcome was delirium using a validated administrative data definition. Logistic regression, and proportional hazards analysis were used to assess outcomes at 30 days, and during continuous use of the medications.
Results
The median (IQR) duration of continuous usage was 113 (30-380) days for Beta-3 agonist, 30 (28-72) days for Oxybutynin, and 62 (30-239) days for the newer anticholinergics. There was no increased risk of delirium in primary analysis among Oxybutynin and newer anticholinergics drug users compared to beta-3 agonist at the 30 days observational window (odds ratio 1.28, 95% CI 0.84-1.96, p=0.25 for Oxybutynin and OR 0.92, 95% CI 0.58-1.46, p=0.73 for newer anticholinergics). The secondary analysis accounting for the period of continuous use showed a small but significant increased risk of delirium with the use of newer anticholinergics drugs compared to beta-3 agonist (HR 1.13, 95% CI 1.02-1.26 for newer anticholinergics).
Conclusions
The use of anticholinergic medications among patients with OAB was not associated with increased risk of delirium compared to beta-3 agonist users at 30 days; however, the risk might be slightly increased with continuous usage of newer anticholinergic medications.
Keywords
Overactive Bladder, Delirium, Anticholinergics, Population-based.