A pooled analysis of the efficacy of fesoterodine for the treatment of overactive bladder, and the relationship between safety, co-morbidity and polypharmacy in patients aged 65 years or older

• Published in: Age and ageing Vol. 46; no. 4; pp. 620 - 626
• Main Authors: Wagg, Adrian, Arumi, Daniel, Herschorn, Sender, Angulo Cuesta, Javier, Haab, Francois, Ntanios, Fady, Carlsson, Martin, Oelke, Matthias
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.07.2017
• Subjects: Age Factors; Aged; Aged patients; Aged, 80 and over; Analysis; Benzhydryl Compounds - adverse effects; Benzhydryl Compounds - therapeutic use; Chi-Square Distribution; Comorbidity; Drug therapy; Drug-Related Side Effects and Adverse Reactions - etiology; Elderly patients; Female; Fesoterodine; Health aspects; Humans; Least-Squares Analysis; Logistic Models; Male; Muscarinic Antagonists - adverse effects; Muscarinic Antagonists - therapeutic use; Odds Ratio; Polypharmacy; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Urinary Bladder - drug effects; Urinary Bladder - physiopathology; Urinary Bladder, Overactive - diagnosis; Urinary Bladder, Overactive - drug therapy; Urinary Bladder, Overactive - epidemiology; Urinary Bladder, Overactive - physiopathology; Urinary incontinence; Urodynamics - drug effects; Urological Agents - adverse effects; Urological Agents - therapeutic use; fesoterodine; multimorbidity; older people; overactive bladder; polypharmacy
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afw252

overactive bladder (OAB) is a common condition in older persons. Antimuscarinic treatment remains the mainstay of treatment of OAB but clinicians have been reluctant to prescribe this to older patients. This study examined efficacy and safety information from patients >65 in fesoterodine trials to reaffirm efficacy and to explore the relationships between treatment emergent adverse events (TEAEs), coexisting medication and co-morbidity. data from 10 double-blind, placebo-controlled studies were analysed. A logistic regression analysis, where TEAE incidence was predicted by treatment, prior antimuscarinic treatment, number of coexisting medications, number of concomitant diseases and all possible combinations of two-way interaction terms with treatment was conducted. of 4,040 patients who participated in trials; fesoterodine treatment was associated with statistically significant reductions in all disease-related and patient-reported outcomes compared to placebo. There was a significant increase in the likelihood of reporting a TEAE in association with the number of coexistent medications (odds ratio (OR) = 1.028, 95% CI: 1.0143-1.044, P < 0.003). The OR of having a TEAE with increase in the number of concomitant diseases was 1.058 (95% CI: 1.044-1.072, P < 0.0001). Central nervous system (CNS) events were few. fesoterodine treatment led to clinically meaningful improvements across all included patient reported outcomes. The number of concomitant conditions had the greatest influence on the likelihood of an adverse event being reported. CNS TEAE were not associated with fesoterodine dose and were low across all categories of concomitant disease and coexisting medication.