Cerebral White Matter Disease and Response to Anti-Cholinergic Medication for Overactive Bladder in an Age-Matched Cohort

Autor: Sherif A. El-Nashar, Sangeeta T. Mahajan, Adonis Hijaz, David Sheyn, Jeffrey Mangel, Emily A. Slopnick, Graham C. Chapman
Rok vydání: 2019
Předmět:
Zdroj: International Urogynecology Journal. 30:1755-1761
ISSN: 1433-3023
0937-3462
DOI: 10.1007/s00192-019-03988-9
Popis: To determine if the presence of cerebral white matter disease (WMD) affects the response to anti-cholinergic medications. This was a retrospective cohort of age-matched patients treated for OAB with anti-cholinergic medications between January 2010 and December 2017. Inclusion criteria were a chief complaint of OAB, never evaluated by a urogynecologist for OAB, treated with a maximum dose for a minimum of 4 weeks, and underwent head computed tomography (CT) within 12 months of starting therapy. Patients with WMD were matched 1:1 by age and number of prior failed antimuscarinics to controls with normal head CTs. Exclusion criteria included incomplete documentation of therapeutic response, non-WMD CT abnormalities, and non-idiopathic OAB. The primary outcome was anti-cholinergic treatment failure. Pairwise analysis between groups was performed using Wilcoxon rank-sum and Fisher’s exact test where appropriate. Univariate logistic regression was performed, and any variable that was associated with treatment failure and a p value ≤ 0.2 was included in the multivariable regression analysis. Sixty-eight cases were matched with 68 controls. Patients with WMD were more likely to have undergone hysterectomy (57.4% vs. 41.2%, p = 0.04) and to use diuretics (31.1% vs. 19.1%, p = 0.04). Patients with WMD were more likely to fail treatment compared with controls (60.7% vs. 29.4%, p = 0.004). After adjusting for confounders, WMD was strongly associated with an increased probability of failure (aOR = 7.31, 95% CI: 1.49–12.20). Additional significant risk factors for treatment failure were the previous number of failed medications (aOR = 3.65 per medication, 95% CI: 1.48–9.01) and a rising HbA1c (aOR: 1.39 per 1.0% increase, 95% CI: 1.0–1.91). WMD is independently associated with anti-muscarinic treatment failure in women with overactive bladder symptoms.
Databáze: OpenAIRE
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