OBJECTIVES: Selective antimuscarinics may offer a favorable safety profile over non-selective antimuscarinics for the management of overactive bladder (OAB) in dementia patients. Therefore, this study examined the risk of mortality associated with non-selective antimuscarinics use among elderly dementia patients with OAB.

METHODS: The study used a retrospective new-user cohort design involving elderly patients with dementia and OAB based on 2013-2015 Medicare Claims data. Incident non-selective antimuscarinic users (oxybutynin, tolterodine, trospium, fesoterodine) were matched to selective users (solifenacin, darifenacin) on propensity scores using Greedy 5→1 matching technique. New users of antimuscarinics were followed until they reached the end of follow-up (6 months), end of study (12/31/2015), switched to a different antimuscarinic class, stopped the antimuscarinic treatment before the study end, or had a gap of more than 7 days in the use of index antimuscarinic class, whichever occurred earlier. Cox proportional-hazards model stratified on matched pairs was used to evaluate the risk of mortality associated with the use of non-selective versus selective antimuscarinics among elderly dementia patients with OAB.

RESULTS: The study identified over one million elderly patients with dementia and OAB (1,049,897). After applying continuous eligibility criteria, 21,848 incident antimuscarinic users were reported. The matching yielded 4,862 patients in each of the two treatment groups. The rate of mortality was 2.6% (126) for non-selective and 1.6% (78) for selective antimuscarinic users in the matched cohort (p-value = 0.0007). The Cox model found 50% higher risk of mortality with non-selective antimuscarinics as compared to selective ones (hazard ratio 1.50; 95% confidence interval 1.04-2.16).

CONCLUSIONS: Use of non-selective antimuscarinics was associated with a 50% increase in the risk of mortality among elderly dementia patients with OAB. Given the high utilization of antimuscarinics in elderly dementia patients with OAB, there is a significant need to optimize their use in this vulnerable population.