Real-world persistence of vibegron in patients aged ≥ 80 years with overactive bladder: a multicenter cohort study

Evidence on real-world persistence of β3-adrenoceptor agonists in patients aged ≥ 80 years with overactive bladder (OAB) is limited. We evaluated vibegron persistence and examined whether polypharmacy, anticholinergic cognitive burden (ACB), and prior anticholinergic exposure were associated with time to treatment discontinuation.

We conducted a retrospective multicenter cohort study across nine urology outpatient departments in Japan (2018-2023). Vibegron-naïve patients aged ≥ 80 years were included, and those with missing key covariates were excluded. The primary analysis compared time to discontinuation between patients taking 1-5 versus ≥ 6 concomitant medications using 1:1 propensity score matching (PSM). Secondary PSM analyses assessed ACB category (0-1 vs. ≥ 2) and prior anticholinergic exposure (yes vs. no). Persistence was evaluated using Kaplan-Meier analysis and Cox proportional hazards models.

Among 889 eligible patients, 838 comprised the complete-case cohort (median age, 83 years; 31.3% female). In the polypharmacy-matched cohort (212 pairs), polypharmacy was associated with shorter persistence (log-rank P = 0.044) and a higher risk of discontinuation (hazard ratio, 1.32; 95% confidence interval, 1.01-1.73). In secondary analyses, persistence did not differ by ACB category (191 pairs; log-rank P = 0.356) or by prior anticholinergic exposure (166 pairs; log-rank P = 0.656).

In patients aged ≥ 80 years initiating vibegron, polypharmacy was associated with shorter treatment persistence after matching, whereas ACB and prior anticholinergic exposure were not. These findings suggest that overall medication burden and care-related factors, rather than anticholinergic burden alone, may influence long-term persistence of OAB therapy in super-elderly patients.