Antimuscarinic persistence patterns in newly treated patients with overactive bladder: a retrospective comparative analysis

Sicras‐Mainar, Antoni; Rejas, Javier; Navarro‐Artieda, Ruth; Aguado-Jodar, A.; Ruiz-Torrejón, A.; Ibáñez-Nolla, Jordi; Kvasz, Marion

doi:10.1007/s00192-013-2250-4

Cited by 41 publications

(30 citation statements)

References 30 publications

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“…Two similar studies to evaluate persistence on-treatment in adults with OAB have been conducted in Spain, which reported higher rates of 12-month persistence on-treatment with solifenacin, fesoterodine or tolterodine monotherapy (range: 30.9–40.2%) compared with our study [34, 35]. These differences may be attributed to several factors: first, in both other studies, retrospective data were extracted from existing medical records from primary healthcare centres in parts of Catalonia and the Balearic Islands, compared with data representative of the overall Spanish population in our study.…”

Section: Discussionsupporting

confidence: 44%

“…These differences may be attributed to several factors: first, in both other studies, retrospective data were extracted from existing medical records from primary healthcare centres in parts of Catalonia and the Balearic Islands, compared with data representative of the overall Spanish population in our study. Second, our sensitivity analyses suggest that extending the period used to define treatment discontinuation results in greater persistence, and one of these other studies (Sicras-Mainar et al, 2014) used a considerably longer period to define treatment discontinuation (52 weeks without prescription renewal) versus our study (30 days in the base case analysis) [34]. In the other prior Spanish study (Sicras-Mainar et al, 2015), OAB patients between 20 and 64 years of age who were active workers were included; therefore, it’s possible these patients may have been healthier or had a better treatment response, compared with the patient population in our study which were selected using less-stringent criteria [35].…”

Section: Discussionmentioning

confidence: 80%

“…Data are available from two retrospective, observational studies which evaluated treatment persistence and adherence in patients receiving pharmacotherapy for OAB in Spain [34, 35]. However, limitations in the design of these studies include possible under-reporting of the incidence of OAB and a lack of evaluation of other variables besides pharmacological treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Nazir

Hakimi

Guelfucci³

et al. 2018

BMC Urol

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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.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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

Nazir

Hakimi

Guelfucci³

et al. 2018

BMC Urol

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“…Adherence is dreadful in adults taking antimuscarinic medications, with one recent study reporting adherence rates at 12 months of 35.8, 31.9, and 30.9% for fesoterodine, solifenacin, and tolterodine, respectively. 51 In a study pending publication, our group noted a medication possession ratio over 80% in only 64% of children treated with antimuscarinics. 52 Although this is better than what has been described in adults, strategies are required to increase adherence and, thus, improve treatment efficacy.…”

Section: Medication Adherence and Persistencementioning

confidence: 90%

Overactive bladder in children

Ramsay¹,

Bolduc²

2017

CUAJ

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Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence, since it negatively affects self-esteem and impairs children's development. From the patient's perspective, urgency and urge incontinence can have a significant impact, negatively affecting their quality of life. For a therapy to have true benefit, changes must not only be statistically significant, but must also be perceived as meaningful by the patient. A stepwise approach is favoured to treat this pathology, starting with behavioural therapy, followed by medical management, and eventually more invasive procedures.Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects, which have been documented with all antimuscarinics to a significantly higher degree than placebo. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine, and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric use by medical authorities in North America. This review will address alternative treatment options for pediatric patients presenting with OAB, from conservative measures to more invasive therapies.

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“…6 The principal drugs used for OAB are antimuscarinic agents. Unfortunately there is a high rate of discontinuation from these drugs, [7][8][9][10][11][12][13] with up to 86% of patients in a UK study stopping therapy after 1 year. 12 In a Canadian study of 31 754 patients with OAB who were treated with antimuscarinics, about 91% discontinued within a 4-year follow-up, and most did not have second-line treatment.…”

Section: Introductionmentioning

confidence: 99%

Persistence and adherence with the new beta-3 receptor agonist, mirabegron, versus antimuscarinics in overactive bladder: Early experience in Canada

Wagg¹,

Franks²,

Ramos³

et al. 2015

CUAJ

101

132

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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.

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Antimuscarinic persistence patterns in newly treated patients with overactive bladder: a retrospective comparative analysis

Abstract: Overall persistence at week 52 was low, but the cumulative probability of persisting with initial therapy was significantly higher for fesoterodine than for solifenacin or tolterodine in clinical practice in Spain.

Cited by 41 publications

References 30 publications

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

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

Overactive bladder in children

Persistence and adherence with the new beta-3 receptor agonist, mirabegron, versus antimuscarinics in overactive bladder: Early experience in Canada

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