Darifenacin treatment for overactive bladder in patients who expressed dissatisfaction with prior extended-release antimuscarinic therapy

SUMMARY Introduction and objective: Patient perception of overactive bladder (OAB) treatment outcomes can be a useful indicator of benefit and may help drive persis- tence on treatment, which is known to be poor in OAB. It remains unclear whether OAB patients dissatisfied with one antimuscarinic can achieve satisfaction with another and supporting data are limited. This study investigated patient- reported outcomes and clinical parameters during darifenacin treatment in OAB patients who expressed dissatisfaction with prior extended-release (ER) oxybutynin or tolterodine therapy (administered for ‡ 1 week within the past year). Methods: This open-label study was conducted in darifenacin-naive OAB patients. Patients received 7.5 mg darifenacin once daily with the possibility of up-titrating to 15 mg after 2 weeks, for up to 12 weeks. Efficacy parameters included the Patient's Per- ception of Bladder Condition (PPBC), patient satisfaction with treatment, micturi- tion frequency and number of urgency and urge urinary incontinence (UUI) episodes. Adverse events (AEs) were also recorded. Results: In total, 497 patients were treated (84.1% women). Darifenacin treatment resulted in statistically signifi- cant improvements in PPBC scores, micturition frequency, urgency and UUI epi- sodes from baseline at 12 weeks. The improvements were similar for patients previously treated with oxybutynin ER or tolterodine ER. More than 85% of patients expressed satisfaction with darifenacin. As noted in other studies, the most common AEs were dry mouth and constipation, but these infrequently resulted in treatment discontinuation, which was low overall. Conclusions: In this study, PPBC score and OAB symptoms were significantly improved, and satisfaction was high during treatment with darifenacin (7.5 ⁄15 mg) in patients who were dis- satisfied with the previous antimuscarinic treatment. What's known • It has been suggested that treatment with the most commonly used antimuscarinic agents for overactive bladder, extended- and immediate- release (ER and IR) oxybutynin and tolterodine, may be unsuccessful because of issues with patient non-compliance and discontinuation before maximal therapeutic benefit can be achieved. • Data demonstrating that patients dissatisfied with one particular OAB treatment may benefit from the use of another antimuscarinic are lacking.