Reply to Beyond Anticholinergic Burden: An Integral Theory Perspective on Overactive Bladder – A Commentary on “A Retrospective Database Analysis of Anticholinergic Burden Among Older Patients With and Without Overactive Bladder in South Korea”

To the editor,

We would like to thank the authors for their letter in response to our publication, “A Retrospective Database Analysis of Anticholinergic Burden Among Older Patients With and Without Overactive Bladder in South Korea” [1]. We are pleased that our work was read with interest and approval, and that it has prompted further discussion.

Our study (NCT03903094) of women and men ≥65 years of age in South Korea focused on concerns regarding anticholinergic burden from antimuscarinic overactive bladder medications [1]. Anticholinergic burden is associated with unwanted clinical effects including cognitive impairment and increased risk of dementia [2, 3]. Our study found that the β3-adrenoreceptor antagonist, mirabegron, did not contribute to this burden [1].

The additional clinical perspective of the integral theory of female incontinence [4, 5] is a valuable contribution to the discussions surrounding the management of overactive bladder and minimizing anticholinergic burden for older women with comorbidities and polypharmacy concerns. As the authors propose, it is important that clinicians do not overlook the importance of anatomical evaluation to fully assess the implications of mechanical dysfunction in overactive bladder. However, this falls outside the scope of our study objectives and we therefore do not have plans to integrate this view into our publication.

We hope that people living with overactive bladder symptoms will benefit from clinicians’ considerations to minimize anticholinergic burden through comprehensive management of mechanical dysfunction and appropriate use of pharmacotherapies with minimal anticholinergic properties.