Ekene Enemchukwu, MD, on guideline-associated trends in OAB therapy use

The release of the first overactive bladder (OAB) guidelines is associated with an increase in OAB diagnoses, a decrease in anticholinergic medication use, and a rise in beta-3 agonist use, according to findings from a recent study.¹

In a recent interview with Urology Times®, Ekene Enemchukwu, MD, MPH, FACS, URPS, discusses these findings in-depth, sharing insights into key takeaways, limitations, and potential future directions.

“That was our primary aim: to try to look at the overall trends of OAB therapy utilization before and after the 2014 AUA/SUFU OAB guidelines and the amendment, and then also publication of the OAB clinical care pathway, which was in 2016,” explained Enemchukwu, an associate professor of urology, and by courtesy, of obstetrics and gynecology (urogynecology), at Stanford Medicine in Palo Alto, California.

Data showed that from 2013 to 2017, there was a 369% increase in the number of new OAB diagnoses. Further, the rate of third-line therapies also almost doubled from 2013 to 2018 (9 to 17 procedures per 1000 OAB patients, P < .001).

Data from the study also showed that prescriptions for oral medications peaked in 2016 and subsequently declined by 17% from 2016 and 2018.

The authors noted, “In 2013, the 2 most prescribed oral medications were oxybutynin (46%) and solifenacin (31.8%). By 2018, mirabegron (18.5%) surpassed solifenacin (16.5%), with oxybutynin still accounting for most prescriptions written (55%). Eighty percent of all initial mirabegron prescriptions were filled by patients over the age of 65.”¹

However, Enemhukwu cautions that these data can only show associations. There may be other factors—such as the publication of a study showing a link between the development of incident dementia and long term use of anticholinergics, as well as a new CPT code for onabotulinumtoxinA—that may have contributed to these trends.

Next steps, according to Enemchukwu, include re-assessing these findings in the context of the recently published 2024 OAB guideline.

She noted, “Putting that all together, what we wanted to see is a baseline of what we had before the 2014 OAB guideline amendment and after [to] see what those trends are. Now [we're] interested in seeing what these trends are going to be now that we have the new guidelines out that have a completely different set-up, with a paradigm shift of moving from step theory therapy to a menu of treatment options that are all couched in shared decision-making.”

REFERENCE

1. Mohamud H, Sinclair, S, Gunamany S, et al. Trends in overactive bladder therapy: Associations between clinical care pathways, practice guidelines, and therapy utilization patterns. Neurourol Urodyn. 2025;44(2):319-329. doi:10.1002/nau.25627