Importance: There is growing concern regarding the risk of cognitive impairment with anticholinergics to treat overactive bladder (OAB). In 2021, updated clinical guidelines cautioned the use of anticholinergic especially in elderly patients and vibegron became the second available Beta-3 agonist medication.

Objective: The primary objective of this study was to examine OAB prescribing patterns from 2020 to 2022.

Study Design: This was a retrospective study at two academic centers between January 2020 and December 2022. Female patients at least 18 years old diagnosed with OAB and newly prescribed anticholinergic or Beta-3 for OAB were included. OAB diagnosis was identified using ICD-10 codes and the electronic medical record was queried for new OAB medication prescriptions in the health system. Patient demographics and provider specialty were abstracted from the medical record.

Results: Between 2020 and 2022, 12,162 patients were prescribed a new anticholinergic or Beta-3 medication. Older, white patients were more likely to be prescribed Beta-3 medications (p<0.001). Publicly insured patients were more likely to receive a Beta-3 prescription while patients with private insurance were more likely to receive an anticholinergic prescription (p<0.001). Provider specialty was significantly different between Beta-3 and anticholinergic prescriptions (p<0.001). Urogynecologists were the leading prescribers of Beta-3 (33.8%), while PCPs prescribed the most anticholinergic (38.6%). When comparing 2020 and 2022 OAB prescriptions by provider specialty, percentage of Beta-3 prescriptions increased for all specialties and percentage of anticholinergic prescriptions decreased (p<0.001).

Conclusion: Consistent with updated guidelines, Beta-3 prescriptions for OAB increased while anticholinergic prescriptions decreased substantially between 2020 and 2022.