Introduction: Antimuscarinics are the principal pharmacological treatment for overactive bladder (OAB), but frequently give rise to anticholinergic side effects, such as dry mouth, a factor leading to poor persistence. The ß 3 -adrenoceptor agonist mirabegron is devoid of significant anticholinergic activity, while being effective in OAB. We evaluated persistence and adherence with mirabegron versus antimuscarinics over 12 months. Methods: We obtained retrospective claims from a Canadian Private Drug Plan database for patients 18 years old and over, with a first claim for mirabegron or antimuscarinics during a 6-month index period (April-September 2013). A 6-month look-back identified those with no prior claims for OAB medication (treatmentnaïve) or ≥1 prior OAB drug (treatment-experienced). Time to end of persistence (≥30 day therapy gap or switch of therapy) was evaluated over 12 months; adherence with medication (medication possession ratio) was also measured. Results: Persistence data from 19 485 patients (74% female, 92% naïve, 19.9% aged ≥65 years) showed that for experienced patients the median number of days on mirabegron was 299 days, compared with a range of 96 to 242 days for the different antimuscarinics; for naïve patients, it was 196 versus 70 to 100 days, respectively. Persistence at 12 months was for mirabegron 39% versus 14% to 35% for antimuscarinics, (experienced) and 30% mirabegron versus 14% to 21% antimuscarinics, (naïve). Patients taking mirabegron demonstrated statistically significantly greater adherence than those taking antimuscarinics. Conclusion: Patients who received mirabegron remained longer on treatment than those treated with antimuscarinics, and had higher 12-month persistence and adherence rates.

ObjectiveWe aimed to compare patient’s and physician’s ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.DesignBaseline data from two prospective multicentre observational studies.Setting29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal.Participants395 patients (≥13 years old) with persistent asthma.MeasuresData on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0–50; medium 51–80; high 81–100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients’ and physicians’ VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation.ResultsHigh inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65–95) mm; 53% VAS>80) and by physicians (84 (68–95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%).ConclusionAlthough both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.

No abstract

p< 0.001), ranging to 13% with oxybutynin IR (HR 2.315; CI: 2.093−2.561; p< 0.001). Median number of days on therapy with mirabegron was 183 (treatment-experienced) and 129 (treatment-naïve), compared with 67−120 and 34−90 days with antimuscarinics, respectively. Mean adherence overall was 68% with mirabegron vs 39−55% with antimuscarinics (each p< 0.05 vs mirabegron). ConClusions: Patients treated with mirabegron had improved persistence and adherence over antimuscarinics. While differences in patient characteristics among the OAB drugs were accounted for within the model, results should be viewed in the light of the likely characteristics of patients started on any new medication to the market; hence this sample may not be reflective of more mature usage.objeCtives: The frequency of side effects in the treatment with anticholinergic drugs are well described in a number of previous studies. However, little is known about the impact of side effects on therapy discontinuation. The aim of the present study was to estimate the frequency of glaucoma in association with urinary incontinence therapy begin and the impact of glaucoma diagnosis on the therapy discontinuation based on real life data. Methods: Data from Disease Analyzer database including 988 general, 95 urologist and 203 gynecologist practices were used. 26,834 patients (17,125 female and 9,709 male) were identified to have received a first-time anticholinergic prescription of UI, namely darifenacin, fesoterodine, oxybutynin, propiverine, solifenacin, tolterodine or trospium. Co-variates studied included demographic data, concomitant diagnoses and potential drug-induced side-effects. Glaucoma (H40) was defined as strict indication for the use of anticholinergic drugs. A Cox proportional hazard regression model was used to estimate the relationship between non-persistence and the diagnosis of glaucoma for up to 36 months. Results: The proportion of patients that were diagnosed with glaucoma during the time of treatment was very similar in each of the study substances. 32 -38 % of patients received a referral to an ophthalmologist and 0.3 -1.2 % of patients were first time diagnosed with glaucoma. Not surprisingly, there was a highly increased risk for treatment discontinuation in patients having glaucoma (HR: 1.46; p < 0.0001). ConClusions: Overall, the potential side effects including the aggravation of diagnosed glaucoma that were registered in the database were rarer than in clinical trials; most likely they were under-reported due to the nature of the registry. However, there was a significant impact of glaucoma on therapy discontinuation. This finding should be taken into account in clinical practice for the use of anticholinergic drugs in patients suffering from glaucoma.

No abstract