Publicly funded overactive bladder drug treatment patterns in Ontario over 15 years: an ecologic study

Introduction — Medication is an important option for patients with overactive bladder (OAB), with four different drugs approved over the last 10 years including the first non-anticholinergic treatment, mirabegron. We set out to describe the number and rate of users of medication for the management of OAB over the last 15 years among residents of Ontario, Canada covered by the public drug programs.

Methods — We conducted a population-based, repeated cross-sectional study examining quarterly publically-funded prescription claims for OAB medications from January 2000 to June 2016 in Ontario, Canada.

Results — We report two major changes in prescription patterns for OAB. The first was the rise of newer, more selective anticholinergics (tolterodine, solifenacin, and darifenacin) replacing oxybutynin. This led to a 54.8% reduction in the rate of users of oxybutynin over the study period from 10.4 users/1,000 beneficiaries in 2000 to 4.7 users/1,000 beneficiaries in 2016. Recently we saw the emergence of mirabegron as the most commonly prescribed treatment for OAB. By the final quarter of the observation period mirabegron was the most commonly used OAB treatment with 25.0% (n=19,411) of all OAB medication users in Ontario (n=77,660).

Conclusion — Our findings highlight the rapid uptake of novel agents and a major shift in the treatment of OAB over the last 3 years.