Long-Term Management of Overactive Bladder with Antimuscarinic Agents

Antimuscarinic therapy is the primary treatment for overactive bladder. Long-term persistence with the therapy can be problematical, and has been linked to both efficacy and tolerability. A number of specific contributory factors to poor persistence can be identified, such as adverse effects of medication, insufficient beneficial effects, inadequate follow-up after initiation of therapy (poor motivation), and unmet or unrealistic expectations (poor communication between the patient and physician). Open-label studies on antimuscarinics overestimate the real-life persistence, which can lead to unrealistic expectations of the physician. Dose flexibility has improved patient compliance, whilst data on extended-release formulations is equivocal. New methods of drug delivery include the oxybutinin transdermal patch (oxybutinin TDS), and data suggest that patients prefer to receive therapy via this patch than as a once-daily pill. Clinically meaningful symptom improvement is one of the strongest predictors of treatment persistence; a patient will tolerate side-effects if the therapy provides clinical benefits. Significant and sustaining improvement in quality of life (QoL) has been proven for all antimuscarinic agents. However, no specific QoL parameter has been identified that correlates with treatment persistence. Since superior efficacy is unlikely to be achieved by any new antimuscarinic compound, improved tolerability is the actual key for patient satisfaction and treatment persistence.