Real-world onabotulinumtoxinA treatment patterns in patients with overactive bladder.

PURPOSE: Utilization patterns of third-line onabotulinumtoxinA for overactive bladder (OAB) symptoms-including discontinuation and use of other therapeutic options during or after treatment-are not well understood. This retrospective analysis of administrative claims was designed to characterize the unmet need for OAB treatment. MATERIALS AND METHODS: A retrospective claims analysis of Optum's deidentified Clinformatics® Data Mart Database (2009-2021) was performed among patients with diagnosis of OAB newly starting onabotulinumtoxinA injection (2015-2017). Study measures were evaluated during an 18-month pretreatment baseline and over a minimum of 36 months of follow-up. These included number of injections, days between injections, other measures of onabotulinumtoxinA utilization, use of second-line pharmacologic treatments, use of device and surgical treatment options, and complications. RESULTS: Of 2505 eligible patients, 535 (21.4%; 66.8 ± 13.3 y, 87.3% females) continued onabotulinumtoxinA throughout the study. The remaining 1970 (78.6%; 71.4 ± 11.6 y, 79.1% females) were considered discontinuers. Of continuers, 57% received ≥5 treatments. Of discontinuers, 84% received ≤2 treatments. Anticholinergics and ß3-adrenoceptor agonist medication use declined in all patients from baseline to follow-up; however, the absolute reduction in the proportion with any medication fill was similar across continuers versus discontinuers (21% vs. 18%, p < 0.0001). Sacral neuromodulation was initiated by 15/535 (3%) of continuers and 137/1970 (7%) of discontinuers (p < 0.0001). No patients initiated percutaneous tibial neuromodulation. CONCLUSIONS: Early discontinuation of onabotulinumtoxinA therapy for OAB is common and most discontinuers do not receive alternative treatments. Providers have the opportunity to educate OAB patients with un- or undertreated symptoms regarding alternative options.

Percutaneous tibial neuromodulation initial therapy compliance and subsequent third-line treatment patterns.

PURPOSE: Percutaneous Tibial Neuromodulation (PTNM) is used to treat Overactive Bladder (OAB). This analysis summarizes patient adherence to PTNM treatment and examines trends of other third-line therapy use during and after PTNM. METHODS: Optum's deidentified Clinformatics® Data Mart Database (CDM) and CMS Research Identifiable Files were queried for adults with OAB symptoms and who underwent PTNM treatment (2019-2020). We evaluated the proportion of patients who completed 12 visits within 1 year, and defined patients as treatment compliant if 12 PTNM visits were completed within 12 weeks. We then identified the proportion of patients who used other third-line therapies after PTNM and stratified these patients based on their PTNM therapy compliance status. RESULTS: 2302 patients met selection criteria from CDM and 16,473 patients from CMS. The proportion of patients completing a full PTNM treatment course increased over time; from 16% at week 12% to 42% by week 52 (CDM) and 24% to 38% (CMS). Other third-line therapy use increased over time and was higher for PTNM noncompliant versus compliant patients at 52 weeks: onabotulinumtoxinA was 6.5% versus 5.7% for noncompliant versus compliant (CMS, p = 0.0661) and 6.4% versus 4.9% (CDM, p = 0.035), SNM trial procedure was 6.5% versus 2.5% (CDM, p = 0.002) and 4.2% versus 2.0% (CMS, p = 0.010). CONCLUSIONS: Most patients are noncompliant with recommended PTNM treatment regimen. Albeit low, third-line therapy was pursued more frequently by noncompliant patients. Given low compliance, the effectiveness of PTNM may be compromised. Alternative implantable technologies may be needed to assure effectiveness of neuromodulation.

Genetic parameters for fertility and production traits in Red Angus cattle.

Heifer pregnancy (HPG) and Stayability (STAY) are female reproductive traits that have EPD reported by the Red Angus Association of America. Challenges arise when making genetic predictions for these traits. Specifically, HPG and STAY phenotypes can only be collected on females retained in the breeding herd and have low heritability estimates. Additionally, STAY is measured late in an animal's life. The objective of this research was to investigate the genetic relationships between HPG or STAY and 13 other traits, which included measurements of growth, carcass, ultrasound, and scrotal circumference. For STAY relationships between mature weight (MW), body condition score (BCS), teat score (TS), and udder suspension score (US) were also evaluated. Data from 142,146 and 164,235 animals were used in the analyses for HPG and STAY, respectively. Genetic relationships were investigated using a series of 2 trait animal models and a REML procedure. In all analyses, the appropriate contemporary groups were included as a fixed effect, and direct genetic as a random effect. Additional fixed effects included as follows: sex for weight, carcass and ultrasound traits, age of dam for weight traits, and age of measurement for ultrasound, carcass, BCS, udder traits, and MW. Maternal genetic effects for preweaning gain (Pre-WG), weaning weight (WW), and yearling weight (YW) were also modeled. Permanent environmental effects of the dam were modeled for the traits Pre-WG and WW. Permanent environment of the individual for the traits MW, BCS, TS, and US was also included. Heritability estimates were 0.12 ± 0.01 and 0.10 ± 0.01 for HPG and STAY, respectively. Heritability estimates for direct genetic effects of production traits were moderate to high in magnitude, maternal heritability estimates were low, and permanent environmental effects accounted for 0.00 to 0.18 of the total variation. The strongest genetic correlations were those among Pre-WGD (0.24 ± 0.08), WWD (0.18 ± 0.08), YWD (0.20 ± 0.07), ultrasound rib eye area direct (0.16 ± 0.08), and ultrasound backfat direct (0.14 ± 0.08) and HPG. The highest genetic correlations were between STAY and WWM (0.54 ± 0.05), YWM (0.36 ± 0.07), backfat (0.53 ± 0.20), marbling score (0.40 ± 0.20), UREA (0.19 ± 0.07), ultrasound backfat (0.37 ± 0.07), TS (0.30 ± 0.11), and US (0.23 ± 0.11). Relationships between HPG or STAY and other traits were minimal. These results suggest that genetic relationships exist between HPG or STAY and other more densely recorded traits.