Patterns of use of antimuscarinic drugs to treat overactive bladder in Denmark, Sweden, and the United Kingdom

PLoS One. 2018 Sep 27;13(9):e0204456. doi: 10.1371/journal.pone.0204456. eCollection 2018.


Purpose: To describe the use of antimuscarinic drugs to treat overactive bladder (OAB) in Denmark, Sweden, and the United Kingdom (UK).

Methods: We identified new users of darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, and trospium aged 18 years or older from the Danish National Registers (2004-2012), the Swedish National Registers (2006-2012), and UK Clinical Practice Research Datalink (2004-2012). Users were followed until disenrollment, cancer diagnosis, death, or study end. Treatment episodes, identified by linking consecutive prescriptions, were described with respect to duration, drug switch, and drug add-on.

Results: Mean age of OAB drug users was 66 years in Denmark (n = 72,917) and Sweden (n = 130,944), and 62 years in the UK (n = 119,912); 60% of Danish and Swedish patients and 70% of UK patients were female. In Denmark, of 224,680 treatment episodes, 39% were with solifenacin, and 35% with tolterodine; 2% were with oxybutynin. In Sweden, of 240,141 therapy episodes, 37% were with tolterodine and 35% with solifenacin; 5% were with oxybutynin. In the UK, of 245,800 treatment episodes, 28% were with oxybutynin, 27% with solifenacin, and 26% with tolterodine. In the three countries, 49%-52% of treatment episodes comprised one prescription and over 80% of episodes ended because of no refill; less than 20% ended because of a switch to another antimuscarinic. During the study years, we observed a change in OAB treatment preference from tolterodine to solifenacin.

Conclusions: In these cohorts, persistence with antimuscarinic drugs was low. By 2012, the preferred drug was solifenacin; oxybutynin use was marginal in Nordic countries compared with the UK.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Denmark
  • Drug Substitution
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscarinic Antagonists / therapeutic use*
  • Practice Patterns, Physicians'* / trends
  • Sweden
  • United Kingdom
  • Urinary Bladder, Overactive / drug therapy*
  • Urinary Bladder, Overactive / epidemiology


  • Muscarinic Antagonists

Grants and funding

This manuscript reports findings from a regulatory-mandated study. Astellas Pharma Global Development, Inc, was the funder; three independent organizations conducted it: RTI Health Solutions, the University of Southern Denmark, and the Karolinska Institutet.Willem Jan Atsma, Kwame Appenteng, and Milbhor D´Silva are employees of Astellas. The funder provided support in the form of funds paid to the each of the collaborating institutions (not to individuals) to cover the effort of authors (all authors) and other staff involved in the conduct of the study, and it provided other study expenses, such as data access. The funder had the opportunity to review the manuscript, but decisions to publish are independent of the funder: the contract granted the research team independent publication rights. Andrea Margulis, Alejandro Arana, Christine Bui, Lisa McQuay and Susana Perez-Gutthann are full-time employees of RTI Health Solutions, a unit of RTI International, an independent nonprofit research organization that does work for government agencies and pharmaceutical companies including Astellas. Jesper Hallas, Nina Sahlertz Kristiansen, and Anton Pottegård, from the University of Southern Denmark, have worked on a project commissioned by Astellas, with funding paid to their employer. Marie Linder and Shahram Bahmanyar are employed and Ina Anveden Berglind was employed at the Centre for Pharmacoepidemiology of the Karolinska Institutet, which receive grants from several entities (pharmaceutical companies, regulatory authorities and contract research organizations) for performance of drug safety and drug utilization studies. The specific roles of authors are articulated in the Author Contributions section.