Re: Antimuscarinic Use in Men Treated with Bladder Outlet Obstruction Medication Therapy

Objective To assess changes over time in the use of antimuscarinics (AM) among visits in adult men treated with bladder outlet obstruction (BOO) medication therapy (ie, alpha blocker and 5-alpha reductase inhibitors). Methods We used the National Ambulatory Medicare Care Survey database (2006-2014) to identify men aged 40 or older, who initiated or continued on BOO medication therapy. Among these visits, we assessed the percentage of AM and evaluated trends of AM use across between 2006 and 2014 using multivariable logistic regression. Results Overall, there were 7561 patient visits in men aged 40 or older, who were treated with BOO medication therapy between 2006 and 2014 which equates to approximately 158 million visits in the United States after incorporating National Ambulatory Medicare Care Survey weights. Overall, AM was used in 3.7% of visits, among those who were treated with BOO medication therapy; use of AM increased with age. In the multivariable analysis, there was no increasing trend in the use of AM in 2006 relative to subsequent years through 2014 (P = .8104). Conclusion Despite a previous study that showed an increasing trend in antimuscarinic use among patients coded for lower urinary tract symptoms or benign prostatic hyperplasia between 1993 and 2010, several recent randomized-controlled trials, and a recommendation in a clinical practice guideline in 2010, we found no increasing trend in antimuscarinic use among visits in men who were treated with BOO medication therapy in 2006 compared to subsequent years. This suggests the potential undertreatment of antimuscarinics and an area for improved prescribing.