A retrospective study of treatment persistence and adherence to mirabegron versus antimuscarinics, for the treatment of overactive bladder in Spain

Abstract

BackgroundPersistence on-treatment with antimuscarinics in patients with overactive bladder (OAB) is reported to be sub-optimal. This retrospective, longitudinal, observational cohort study assessed treatment persistence with β3-adrenoceptor agonists (i.e. mirabegron) and antimuscarinics, both classes of OAB pharmacotherapy, in patients with OAB in Spain.MethodsAdults who received mirabegron or an antimuscarinic in routine clinical practice (1 June–31 October 2014), were identified from anonymised prescription data within the Spanish Cegedim Electronic Medical Records database. The primary endpoint, treatment persistence (time to treatment discontinuation [TTD] and the proportion of patients remaining on-treatment after 12 months), was unadjusted for potential confounders. Multivariate Cox regression models of persistence, adjusted for baseline characteristics, were used to compare differences in treatment groups. Adjusted subgroup analyses (target OAB drug, age, treatment status and sex) and sensitivity analyses (extending the time used to define treatment discontinuation from 30 days [base-case] to 45, 60 or 90 days without prescription renewal) were also performed.ResultsOverall, 1798 patients received mirabegron (N = 1169) or an antimuscarinic (N = 629); the mean age was 66.42 years. Median TTD was longer for mirabegron versus antimuscarinics (90 vs 56 days) and a higher proportion of patients who received mirabegron were persistent after 12 months (20.2% vs 10.2%); multivariate analyses indicated significantly greater persistence with mirabegron versus antimuscarinics (hazard ratio [HR]: 1.52; 95% confidence interval [CI]: 1.37–1.70; p < 0.001). Significant differences were also observed in subgroup analyses of mirabegron versus individual antimuscarinics (median TTD: 90 vs [range] 28–60 days; HR range: 1.21–2.17; p ≤ 0.013) and in all other subgroups assessed (p < 0.001). Sensitivity analysis showed that the median TTD for mirabegron increased by up to 31 days, and was significantly longer versus antimuscarinics across all adjusted periods (HR range: 1.43–1.53; all p < 0.001).ConclusionsPatients with OAB in Spain who received mirabegron experienced longer persistence on-treatment than those who received antimuscarinics and the proportion of patients persistent on-treatment at 12 months with mirabegron was two-times higher versus antimuscarinics. These data may provide strategic insights for clinicians and policy makers involved in the management of OAB.Electronic supplementary materialThe online version of this article (10.1186/s12894-018-0390-z) contains supplementary material, which is available to authorized users.

Overactive bladder medication: Persistence, drug switching, and reinitiation

“…We demonstrated that the TTD and 12‐month persistence rates of OAB medication with antimuscarinics and mirabegron were 91 days and 24% and 245 days and 41% ( p < .0001), respectively. These figures are better than those of previous reports that used data from pharmaceutical claims databases, where the TTD and 12‐month persistence rates were reported to be 50–60 days and 17%–20%, respectively, for antimuscarinics and 90–170 days and 24%–38%, respectively, for mirabegron 5,13,14 . However, most patients discontinued the medication within 1 year.…”

“…These figures are better than those of previous reports that used data from pharmaceutical claims databases, where the TTD and 12-month persistence rates were reported to be 50-60 days and 17%-20%, respectively, for antimuscarinics and 90-170 days and 24%-38%, respectively, for mirabegron. 5,13,14 However, most patients discontinued the medication within 1 year. Wada et al 15 reported a 1-year persistence rate >60% for mirabegron using a retrospective chart review.…”

Adding mirabegron after intravesical onabotulinumtoxinA injection improves therapeutic effects in patients with refractory overactive bladder

“…Second, the patient number in each group was small, and more than half of the patients had dropped out of the study by the end of the 12‐month follow‐up period. However, the dropout rate of the study was similar to those of several clinical long‐term studies which disclosed low adherence and persistence to solifenacin and mirabegron in OAB patients in real‐world study 3,21,22 . The dropout rate could be as high as 60% ~ 90% during 12‐month follow‐up.…”

Persistence with mirabegron or antimuscarinic treatment for overactive bladder syndrome: Findings from the PERSPECTIVE registry study

“…Conversely, the opposite finding was noted in a Japanese urology clinic study, which reported 12‐month persistence rates of 12.2% and 20.1% with mirabegron and solifenacin, respectively 35 . It is important to note, however, that the Japanese urology clinic study was a prospective, randomized trial when the other studies mentioned above were retrospective database analyses, and these differences in study design may partially explain the contradictory results obtained 13‐15,32‐35 . In addition, the differences observed in the Japanese study were not statistically significant, which was possibly due to the relatively small study population of 148 patients 35 .…”

“…In agreement with the specific persistence findings mentioned above, previous real‐world analyses conducted in Canada, Japan, Spain, the US, and the UK typically showed that patients treated with mirabegron remained on treatment longer than those treated with antimuscarinics. 13 , 14 , 15 , 32 , 33 , 34 In these previous studies, 12‐month persistence rates of between 14% and 38% were noted for mirabegron, and rates of between 3% and 25% were reported with antimuscarinics. Conversely, the opposite finding was noted in a Japanese urology clinic study, which reported 12‐month persistence rates of 12.2% and 20.1% with mirabegron and solifenacin, respectively.…”