Treatment Trajectories and Symptom Burden in Overactive Bladder: Long-Term Follow-Up of a Prospective, Nonrandomized Cohort

Background: Long-term overactive bladder (OAB) care involves treatment changes that are not captured by initial-prescription persistence alone. We examined treatment pathways, symptom burden, and xerostomia. Methods: This prospective nonrandomized cohort included 106 adults initially managed with solifenacin 5 mg, solifenacin 10 mg, or mirabegron 50 mg. Telephone interviews were completed by 83 participants after a mean of 32.6 months (range 29.8–35.3); 76 had reliable linked data, and 75 had current Overactive Bladder Symptom Score (OABSS). Treatment pathways, reasons for modification, and global patient-reported outcomes were described. Current antimuscarinic use and xerostomia were examined using exact testing and logistic regression. Results: 20 participants were receiving their index oral regimen, 22 a different oral monotherapy, 17 no treatment, 16 nonoral or other urological management, and one combination therapy. Median current OABSS was 3; 41/75 participants achieved a reduction of at least three points. Global improvement was reported by 65/76. Among 17 untreated participants, eight reported symptom improvement as the reason for discontinuation. Xerostomia occurred in 21/32 current antimuscarinic users and 11/44 nonusers (odds ratio 5.73, 95% confidence interval 2.11–15.55). Conclusions: At long-term follow-up, most patients reported sustained symptomatic improvement, often sufficient to permit discontinuation; discontinuation therefore did not uniformly indicate treatment failure. Current antimuscarinic use was associated with xerostomia. These observations support periodic reassessment of symptoms and tolerability without establishing comparative drug efficacy.