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Increased risk of dementia among patients with overactive bladder treated with an anticholinergic medication compared to a beta-3 agonist: a population-based cohort study
Welk B, McArthur E.. BJU international, 2020-03-19
Topic: Drug trials: efficacy and safety
Objective To determine if there is an increased risk of dementia among patients with overactive bladder (OAB) starting an anticholinergic medication compared to those starting a beta-3 agonist. Methods We conducted a population-based, retrospective, matched cohort study using linked administrative data from Ontario, Canada from 2010 to 2018. We matched 47 324 new users of anticholinergic medications (oxybutynin, tolterodine, solifenacin, darifenacin, fesoterodine, trospium) to 23 662 new users of a beta-3 agonist medication (mirabegron); all of the included medications are only indicated for the treatment of OAB. We measured 75 baseline variables (including comorbid conditions, recent medications, and prior healthcare utilization) and used these to create a propensity score; groups were similar across all measured variables after matching. The primary exposure was the class of OAB medication (anticholinergic or beta-3 agonist). The primary outcome was dementia using a validated administrative data definition. Results The most common anticholinergics used were tolterodine (40%), oxybutynin (29%) and solifenacin (26%). The median (interquartile range [IQR]) prescription duration of anticholinergics was 30 (30-170) days. The median (IQR) prescription duration of a beta-3 agonist (mirabegron) was 64 (30-317) days. There was an increased risk of dementia among anticholinergic users compared to beta-3 agonist users (hazard ratio 1.23, 95% confidence interval 1.12-1.35). There was a significant effect modification based on both gender and age; men and those aged ≤75 years on anticholinergics had the highest risk of dementia relative to similar beta-3 agonist users. Conclusions The use of anticholinergic medications among patients with OAB was associated with an increased risk of new-onset dementia compared to beta-3 agonist users. These results address the potential protopathic bias present in other studies on this topic and support the association between anticholinergic medication use and dementia.
Key findings
- Objective To determine if there is an increased risk of dementia among patients with overactive bladder (OAB) starting an anticholinergic medication compared to those starting a beta-3 agonist.
- Results The most common anticholinergics used were tolterodine (40%), oxybutynin (29%) and solifenacin (26%).
- There was an increased risk of dementia among anticholinergic users compared to beta-3 agonist users (hazard ratio 1.23, 95% confidence interval 1.12-1.35).
- There was a significant effect modification based on both gender and age; men and those aged ≤75 years on anticholinergics had the highest risk of dementia relative to similar beta-3 agonist users.
- Conclusions The use of anticholinergic medications among patients with OAB was associated with an increased risk of new-onset dementia compared to beta-3 agonist users.
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Study details
- Study designcohort study
- Evidence strengthModerate
How this study scored 54/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record and institution's track record, so those were left out: it earned 33 of the 61 points we could judge it on, which is 54 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (BJU international) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | 2 / 3 | PubMed indexes it as a multicentre study |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 32167223) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 33 / 61 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 33 of the 61 points we could judge it on is 54 out of 100. |
| Total | 54 / 100 | — |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Welk, B., & McArthur, E. (2020). Increased risk of dementia among patients with overactive bladder treated with an anticholinergic medication compared to a beta-3 agonist: a population-based cohort study. BJU international. https://doi.org/10.1111/bju.15040
Vancouver
Welk B, McArthur E. Increased risk of dementia among patients with overactive bladder treated with an anticholinergic medication compared to a beta-3 agonist: a population-based cohort study. BJU international. 2020. doi:10.1111/bju.15040. PMID: 32167223.
BibTeX
@article{welk2020-32167223,
author = {Welk, B. and McArthur, E.},
title = {{Increased risk of dementia among patients with overactive bladder treated with an anticholinergic medication compared to a beta-3 agonist: a population-based cohort study}},
journal = {BJU international},
year = {2020},
doi = {10.1111/bju.15040},
pmid = {32167223},
url = {https://doi.org/10.1111/bju.15040}
}
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