6/19/11

Inhaled Anticholinergic Medications Increase Risk for Acute Urinary Retention Among Men

News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD


May 26, 2011 — Use of short- and long-acting inhaled anticholinergic medications (IACs) is associated with an increased risk for acute urinary retention (AUR) in men with chronic obstructive pulmonary disease (COPD), according to the results of a population-based, nested case-control study reported in the May 23 issue of theArchives of Internal Medicine.
"...IACs are widely used treatments for ...COPD," write Anne Stephenson, MD, PhD, from St. Michael's Hospital in Toronto, Ontario, Canada, and colleagues. "The systemic anticholinergic effects of IAC therapy have not been extensively studied. This study sought to determine the risk of ...AUR in seniors with COPD using IACs."
From April 1, 2003, to March 31, 2009, the investigators used population-based linked databases from Ontario, Canada, to identify 565,073 individuals at least 66 years old with COPD. Case patients — identified as those who had a hospitalization, same-day surgery, or emergency department visit for AUR — were matched with up to 5 control participants. A comprehensive drug benefits database allowed detection of IAC use, and the association between IAC use and AUR was analyzed with conditional logistic regression.
AUR developed in 9432 men and 1806 women. Compared with nonusers of IACs, men who had just started IAC treatment had an increased risk for AUR (adjusted odds ratio [OR], 1.42; 95% confidence interval [CI], 1.20 - 1.68). This risk was further increased in men with evidence of benign prostatic hyperplasia (OR, 1.81; 95% CI, 1.46 - 2.24). Compared with users of a single IAC, men using both short- and long-acting IACs had a significantly higher risk for AUR (OR, 1.84; 95% CI, 1.25 - 2.71). Their risk was also increased to an even greater extent vs nonusers (OR, 2.69; 95% CI, 1.93 - 3.76).
"Use of short- and long-acting IACs is associated with an increased risk of AUR in men with COPD," the study authors write. "Men receiving concurrent treatment with both short- and long-acting IACs and those with evidence of benign prostatic hyperplasia are at highest risk."
Limitations of this study include inability to assess drug dosage; lack of patient-level data on lung function, smoking history, renal impairment, and disease severity; use of prescription data as a proxy for drug use; and difficulty in distinguishing individuals with chronic urinary retention from those with AUR. In addition, there may have been some false-positive COPD diagnoses, and the findings may not be generalizable to individuals treated solely in ambulatory outpatient clinics.
"Physicians and the public need to be aware of the potential for this significant adverse event so that preventive measures and potential therapy can be considered," the study authors conclude.
Patients Should Be Informed
In an accompanying commentary, Sonal Singh, MD, MPH, from The Johns Hopkins University in Baltimore, Maryland, and Curt D. Furberg, MD, PhD, from Wake Forest University in Winston-Salem, North Carolina, discuss the implications of the accumulating evidence regarding serious harm associated with IAC use.
"Physicians should inform patients with COPD about the risk of AUR associated with IACs and determine the optimal choice of therapy for their patients after eliciting patient preferences for various patient-oriented outcomes in a shared decision-making context," Drs. Singh and Furberg write. "Clinicians need reliable, accurate, and comprehensive safety data to determine whether the increasing morbidity and mortality in COPD are due to the underlying disease or are treatment induced. Regulators ought to review safety data for all inhaled bronchodilators, with particular attention to vulnerable subgroups at the highest risk of systemic anticholinergic effects, such as older men with BPH [benign prostatic hyperplasia] or patients with preexisting arrhythmias, who are often excluded from RCTs [randomized controlled trials] of efficacy."
The study was funded by a grant from the Canadian Institutes of Health Research and was conducted at the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-term Care. The study authors have disclosed no relevant financial relationships. Dr. Singh has received support from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and from the NIH Roadmap for Medical Research.
Arch Intern Med. 2011;171:914-920, 920-922. Abstract

regards, taniafdi ^_^
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6/19/11

Inhaled Anticholinergic Medications Increase Risk for Acute Urinary Retention Among Men

News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD


May 26, 2011 — Use of short- and long-acting inhaled anticholinergic medications (IACs) is associated with an increased risk for acute urinary retention (AUR) in men with chronic obstructive pulmonary disease (COPD), according to the results of a population-based, nested case-control study reported in the May 23 issue of theArchives of Internal Medicine.
"...IACs are widely used treatments for ...COPD," write Anne Stephenson, MD, PhD, from St. Michael's Hospital in Toronto, Ontario, Canada, and colleagues. "The systemic anticholinergic effects of IAC therapy have not been extensively studied. This study sought to determine the risk of ...AUR in seniors with COPD using IACs."
From April 1, 2003, to March 31, 2009, the investigators used population-based linked databases from Ontario, Canada, to identify 565,073 individuals at least 66 years old with COPD. Case patients — identified as those who had a hospitalization, same-day surgery, or emergency department visit for AUR — were matched with up to 5 control participants. A comprehensive drug benefits database allowed detection of IAC use, and the association between IAC use and AUR was analyzed with conditional logistic regression.
AUR developed in 9432 men and 1806 women. Compared with nonusers of IACs, men who had just started IAC treatment had an increased risk for AUR (adjusted odds ratio [OR], 1.42; 95% confidence interval [CI], 1.20 - 1.68). This risk was further increased in men with evidence of benign prostatic hyperplasia (OR, 1.81; 95% CI, 1.46 - 2.24). Compared with users of a single IAC, men using both short- and long-acting IACs had a significantly higher risk for AUR (OR, 1.84; 95% CI, 1.25 - 2.71). Their risk was also increased to an even greater extent vs nonusers (OR, 2.69; 95% CI, 1.93 - 3.76).
"Use of short- and long-acting IACs is associated with an increased risk of AUR in men with COPD," the study authors write. "Men receiving concurrent treatment with both short- and long-acting IACs and those with evidence of benign prostatic hyperplasia are at highest risk."
Limitations of this study include inability to assess drug dosage; lack of patient-level data on lung function, smoking history, renal impairment, and disease severity; use of prescription data as a proxy for drug use; and difficulty in distinguishing individuals with chronic urinary retention from those with AUR. In addition, there may have been some false-positive COPD diagnoses, and the findings may not be generalizable to individuals treated solely in ambulatory outpatient clinics.
"Physicians and the public need to be aware of the potential for this significant adverse event so that preventive measures and potential therapy can be considered," the study authors conclude.
Patients Should Be Informed
In an accompanying commentary, Sonal Singh, MD, MPH, from The Johns Hopkins University in Baltimore, Maryland, and Curt D. Furberg, MD, PhD, from Wake Forest University in Winston-Salem, North Carolina, discuss the implications of the accumulating evidence regarding serious harm associated with IAC use.
"Physicians should inform patients with COPD about the risk of AUR associated with IACs and determine the optimal choice of therapy for their patients after eliciting patient preferences for various patient-oriented outcomes in a shared decision-making context," Drs. Singh and Furberg write. "Clinicians need reliable, accurate, and comprehensive safety data to determine whether the increasing morbidity and mortality in COPD are due to the underlying disease or are treatment induced. Regulators ought to review safety data for all inhaled bronchodilators, with particular attention to vulnerable subgroups at the highest risk of systemic anticholinergic effects, such as older men with BPH [benign prostatic hyperplasia] or patients with preexisting arrhythmias, who are often excluded from RCTs [randomized controlled trials] of efficacy."
The study was funded by a grant from the Canadian Institutes of Health Research and was conducted at the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-term Care. The study authors have disclosed no relevant financial relationships. Dr. Singh has received support from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and from the NIH Roadmap for Medical Research.
Arch Intern Med. 2011;171:914-920, 920-922. Abstract

regards, taniafdi ^_^
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