Factors Impacting Continuation of Onabotulinum Toxin Therapy for Idiopathic and Neurogenic Urgency Urinary Incontinence

INTRODUCTION: We investigated demographic, diagnostic, and socioeconomic variables associated with continuation and discontinuation of onabotulinum toxin (BTX) therapy in adult patients treated for idiopathic and neurogenic urgency urinary incontinence (UUI). METHODS: Patients who initiated BTX for UUI between 2015 and 2018 at a tertiary academic referral center were identified from CPT codes and followed through 2020 (n = 723). The cohort was divided into patients who continued BTX therapy (received ≥1 BTX treatment within 2 years of initial injection) (Group A), and patients who stopped BTX (received no additional BTX for at least 2 years after the last injection) (Group B). Demographic variables were extracted using chart review and administrative data. Socioeconomic differences were estimated using affluence index (AI) and disadvantage index (DI) from their last botox injection, calculated using U.S. census tract indicators. AI factors include household income, professions of household members, and educational background. DI factors include neighborhood proportion of female-headed households, receiving public assistance or not, household income level, and level of employment. Indexes ranged from 0.0 (least affluent or disadvantaged) to 1.0 (most affluent or advantaged). RESULTS: The mean cohort age (n = 723) was 57% and 69% were female. After the initial injection, 40% received additional injections within 2 years (Group A) and 60% did not (Group B). There were no demographic differences between groups. Univariate comparison of affluence and disadvantage indexes revealed Group A affluence was not significantly different (AI = 0.38 vs 0.37, p = 0.2) but was slightly less disadvantaged (DI = 0.072, vs. 0.081; p = 0.036) than Group B. Multivariable analysis including demographic and socioeconomic factors demonstrated that higher affluence index was associated with lower odds of BTX discontinuation (OR = 0.90 per 0.1-unit increase, 95% CI: 0.82-0.99, p = 0.029), while there was insufficient evidence of an association between disadvantage index and discontinuation (OR = 1.23 per 0.1-unit increase, 95% CI: 0.99-1.54, p = 0.06). After adding neurogenic versus non-neurogenic etiology of UUI, the socioeconomic associations were no longer significant. Patients with a non-neurogenic diagnosis had significantly greater odds of BTX discontinuation than patients with a neurogenic diagnosis (OR = 1.97, 95% CI: 1.35-2.89, p < 0.001). CONCLUSION: Approximately 40% of patients continued BTX treatment for UUI beyond the initial injection period. Neurogenic diagnosis was strongly associated with treatment persistence, with non-neurogenic patients demonstrating greater odds of discontinuation. Socioeconomic factors were not independently associated with discontinuation after adjustment for clinical diagnosis. CLINICAL TRIAL REGISTRATION: This is a retrospective study with IRB approval. This study is not a clinical trial and will not be registered as a clinical trial.