Certain anticholinergic drugs for OAB associated with an increased risk for dementia

Researchers have found an increased risk for dementia in older adults taking anticholinergic drugs for the management of overactive bladder (OAB), specifically with the use of oxybutynin hydrocholoride, solifenacin succinate, and tolterodine tartrate.

The findings, published in BMJ Medicine in November 2024, “suggest the need for clinicians to consider prescribing alternative treatments that are not significantly associated with a risk of dementia,” say investigator Barbara Iyen (University of Nottingham, UK) and colleagues.

They note that there was not a significantly increased risk for dementia with long-term use of darifenacin, fesoterodine fumarate, flavoxate hydrocholoride, propoverine hydrocholoride, or trospium chloride.

However, the team points out that there were limited numbers of patients in some of these subgroups, and so “we cannot conclusively exclude the possibility of a risk of dementia with these drug treatments.”

The nested case-control study involved 170,742 people with dementia and 804,385 without matched for age, sex, general practice, and timeframe. Medical health records for both primary and secondary care were obtained via the Clinical Practice Research Datalink GOLD database.

The patients were aged 55 years and older (median age 83 years) and the majority (63%) were women.

In all, 9.0% of patients with dementia and 7.9% of those without dementia were prescribed anticholinergic drugs for the treatment of OAB in the 3 to 16 years before dementia or the index date in controls. The most common of these were oxybutynin hydrochloride (4.7 and 4.1%, respectively), tolterodine tartrate (4.1 and 3.5%), and solifenacin succinate (2.8 and 2.4%).

After adjusting for sociodemographic characteristics, clinical comorbidities, and factors known to increase the risk for dementia, the cumulative use of any anticholinergic drug was associated with a significant 18% increased risk for dementia versus no use. The increase in risk was slightly greater among men than women, at 22% versus 16%.

For the individual anticholinergics, there was a significant 31% increased risk for dementia with cumulative use of oxybutynin hydrocholoride at a standardized daily dose of 366–1095 versus no use and a significant 28% increased risk at a standardized daily dose of more than 1095. The standardized daily dose was calculated as the prescribed daily dose divided by the WHO defined daily dose.

There were also similarly increased risks for dementia with the cumulative use of solifenacin succinate (18% and 29%, respectively) and tolterodine tartrate (27% and 25%, respectively).

The authors suggest that “the greater ability of oxybutynin hydrochloride, tolterodine tartrate, and solifenacin succinate to penetrate the blood-brain barrier than other anticholinergic drugs,” might partly explain their findings.

In sensitivity analyses, the association between anticholinergic use and dementia risk was stronger for patients younger than 80 years of age than those older than 80 years.

The authors conclude: “The management of symptoms of an overactive bladder in older adults should include shared decision making between healthcare practitioners and patients that take into account the available treatment options, effectiveness, and possible long term risks and consequences of these treatments.”

 News stories are provided by medwireNews, which is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group

Read the article here: BMJ Med 2024: 3; e000799

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