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Overactive bladder: cardiovascular safety of antimuscarinic treatments in the UK

A recent observational study performed with health care data, published in the journal Pharmacotherapy, found an increased risk for cardiovascular side effects in users of oxybutynin vs tolterodine, whereas the risk was lower in users of solifenacin vs tolterodine.

Researchers used data from the United Kingdom-based Clinical Practice Research Datalink to evaluate 119,912 patients (mean age, 62 years) newly prescribed specified antimuscarinics (darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine or trospium) to treat overactive bladder. Using tolterodine as reference, propensity-score-stratified incidence rate ratio (IRR) was determined for acute myocardial infarction, stroke, cardiovascular mortality, major adverse cardiac events (MACEs) and all-cause death for individual antimuscarinic drugs.

During a mean follow-up of 3.3 years, compared with current use of tolterodine, current use of oxybutynin was associated with 14% (IRR, 1.14; 95% CI, 1.01-1.30) increased risk for MACE, whereas current use of solifenacin was associated with 65% reduced risk for MACE (IRR, 0.65; 95% CI, 0.56-0.76). IRRs for acute myocardial infarction, stroke, cardiovascular mortality and all-cause mortality were consistently >1 for current exposure to oxybutynin vs tolterodine and <1 for current exposure to solifenacin vs tolterodine. IRRs for trospium were all near 1, whereas propensity score-adjusted IRRs could not be determined for darifenacin and fesoterodine because of insufficient use.

The authors state that the distribution of cardiovascular risk factors in the studied population was similar across different users of overactive bladder drugs. They state further that although residual differences in these factors were controlled, residual confounding cannot be ruled out.


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