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Alzheimer's disease and related dementias risk: Comparing users of non‐selective and M3 ‐selective bladder antimuscarinic drugs
Author(s) -
Barthold Douglas,
Marcum Zachary A.,
Gray Shelly L.,
Zissimopoulos Julie
Publication year - 2020
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.5098
Subject(s) - medicine , solifenacin , tolterodine , dementia , incidence (geometry) , odds ratio , overactive bladder , disease , physics , alternative medicine , optics , pathology
Abstract Purpose Bladder antimuscarinic (BAM) drug use is associated with increased risk of Alzheimer's disease and related dementias (ADRD). It is hypothesized that BAMs with non‐selective receptor binding may increase ADRD risk more than M3‐selective BAMs. This study compared ADRD risk for users of non‐selective and M3‐selective BAMs and examines ADRD risk associated with overall BAM use. Methods Retrospective cohort study of Medicare claims for 71 688 individuals who used BAM drugs during 2007‐2009 without an ADRD diagnosis. We compared ADRD incidence (2011‐2016) between non‐selective BAM users (fesoterodine, flavoxate, oxybutynin, tolterodine, trospium) and M3‐selective BAM users (darifenacin, solifenacin). Logistic regressions compared individuals using target drugs in the same category of total standardized daily doses (TSDD) as a standardized measure of drug exposure, and adjusted for age, sex, race/ethnicity, healthcare utilization, other medication use, socioeconomic status, and comorbidities. Secondary analyses compared ADRD risk associated with different doses of BAMs overall. Results Non‐selective BAM use (compared to M3‐selective) was not significantly associated with ADRD incidence. Odds ratios for non‐selective use were 0.97 (CI: 0.89‐1.04) for 1‐364 TSDD, 0.94 (CI: 0.83‐1.06) for 365‐729, 1.00 (CI: 0.87‐1.16) for 730‐1094, and 1.03 (CI: 0.88‐1.20) for >1094. Higher TSDD of BAMs overall (combining both non‐selective and M3‐selective BAMs), when compared to 1‐364 TSDD, were associated with increased ADRD incidence (OR = 1.05 (CI: 0.99‐1.10) for 365‐729, OR = 1.11 (CI: 1.05‐1.17) for 730‐1094, and OR = 1.10 (CI: 1.04‐1.15) for >1094). Conclusions Non‐selective and M3‐selective BAM users had similar odds of ADRD incidence, and BAM use overall was significantly associated with ADRD incidence.