Comparative Efficacy and Safety of Medical Treatments for the Management of Overactive Bladder: A Systematic Literature Review and Mixed Treatment Comparison

Maman, Khaled; Aballéa, Samuel; Nazir, Jameel; Desroziers, K.; Neine, M.; Siddiqui, Emad; Odeyemi, Isaac; Hakimi, Zalmaï

doi:10.1016/j.eururo.2013.11.010

Cited by 232 publications

(210 citation statements)

References 52 publications

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“…Both classes of drugs exhibit similar efficacy, but unlike antimuscarinics, mirabegron is not associated with anticholinergic side effects. [10][11][12] Patients are usually initiated on an antimuscarinic, with dose escalation if symptom improvement is inadequate. This may increase the anticholinergic burden, the risk of bothersome side effects and treatment discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Mirabegron as Add-On Treatment to Solifenacin in Patients with Incontinent Overactive Bladder and an Inadequate Response to Solifenacin Monotherapy

et al. 2016

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Materials and Methods:Incontinent OAB patients, despite 4-weeks single-blind daily solifenacin 5 mg, were randomized 1:1:1 to double-blind, daily combination (mirabegron 50 mg/solifenacin 5 mg), solifenacin 5 or 10 mg for 12 weeks. Mirabegron dose was increased from 25 mg to 50 mg after week 4. Symptom Bother, health-related quality of life (HRQoL), and patient perception of bladder condition (PPBC) were assessed using respective OAB-q and PPBC questionnaires; responder rates were based on 50% reduction in daily incontinence, zero incontinence episodes and <8 micturitions/24 hours, and minimal important differences in OAB-q and PPBC.Results: Overall 2,174 patients, median age 59 years, were randomized to combination (n=727), solifenacin 5 mg (n=728) or 10 mg (n=719). Symptom Bother, total HRQoL and its subscales (Coping, Concern, and Social) and PPBC were significantly improved with combination vs solifenacin monotherapy (P<0.05). The odds of achieving clinically meaningful improvements in incontinence and micturition frequency, Symptom Bother, HRQoL and PPBC, was significantly higher with combination vs solifenacin monotherapy.The odds (95% CI) of becoming continent was 47% (OR 1.47; 1.17, 1.84; p=0.001) and 28% (OR 1.28; 1.02, 1.61; p=0.033) higher with combination vs solifenacin 5 and 10 mg, respectively. Conclusion:Significantly more patients on combination achieved clinically meaningful improvements in incontinence and micturition frequency, which were accompanied by similar improvements in PPBC, Symptom Bother and HRQoL. BESIDE Responder 3rd draft February 2016 4 Overactive bladder (OAB) is defined by symptoms of urinary urgency, usually accompanied by increased daytime frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology. 1,2 Urgency urinary incontinence affects approximately one third of all OAB cases. 3 Compared with continent ("dry") OAB patients, incontinent ("wet") OAB patients experience greatly diminished quality of life (QoL), reporting higher rates of depression, psychological and emotional distress, and social isolation. 4,5 The severity of urgency urinary incontinence is strongly correlated with reductions in QoL,6 suggesting that incontinent OAB patients who are refractory to treatment are likely to be extremely dissatisfied with their QoL. Daily activities are often severely disrupted, and incontinent patients are more likely to require assistance with daily activities, placing an additional financial burden on society. 7 OAB patients are more likely to seek treatment once symptoms affect health-related quality of life (HRQoL), 8 and to persist with treatment if HRQoL improves. 9 Objective efficacy assessments are essential in OAB trials. However, the greatest treatment benefit experienced by patients is likely to be related to improvements in QoL. It is, therefore, equally important to assess subjective, patient-reported outcomes (PROs) including HRQoL and perception of symptoms, and how these correlate wit...

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Section: Discussionmentioning

confidence: 99%

Mirabegron as Add-On Treatment to Solifenacin in Patients with Incontinent Overactive Bladder and an Inadequate Response to Solifenacin Monotherapy

et al. 2016

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“…9 Secondly, newer anticholinergics introduced (tolterodine, solifenacin and darifenacin) were likely perceived to be more tolerable than oxybutynin due to their increased specificity for muscarinic receptors. 10 This increased specificity is thought to reduce the rate and severity of adverse events and improve tolerability. 10 These perceived improvements were highly marketed by manufacturers as major reasons to use newer agents over oxybutynin, especially among older patients.…”

Section: Discussionmentioning

confidence: 99%

“…10 This increased specificity is thought to reduce the rate and severity of adverse events and improve tolerability. 10 These perceived improvements were highly marketed by manufacturers as major reasons to use newer agents over oxybutynin, especially among older patients. With a median age of 73 among Ontario OAB users 7 a large number of users were shifted away from older treatments by prescribers.…”

Section: Discussionmentioning

confidence: 99%

Publicly funded overactive bladder drug treatment patterns in Ontario over 15 years: An ecological study

Tadrous

Khuu

Mamdani³

et al. 2017

CUAJ

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Introduction: Medication is an important option for patients with overactive bladder (OAB), with four different drugs approved over the last 10 years including the first non-anticholinergic treatment, mirabegron. We set out to describe the number and rate of users of medication for the management of OAB over the last 15 years among residents of Ontario, Canada covered by the public drug programs. Methods: We conducted a population-based, repeated cross-sectional study examining quarterly publically-funded prescription claims for OAB medications from January 2000 to June 2016 in Ontario, Canada. Results: We report two major changes in prescription patterns for OAB. The first was the rise of newer, more selective anticholinergics (tolterodine, solifenacin, and darifenacin) replacing oxybutynin. This led to a 54.8% reduction in the rate of users of oxybutynin over the study period from 10.4 users/1,000 beneficiaries in 2000 to 4.7 users/1,000 beneficiaries in 2016. Recently we saw the emergence of mirabegron as the most commonly prescribed treatment for OAB. By the final quarter of the observation period mirabegron was the most commonly used OAB treatment with 25.0% (n=19,411) of all OAB medication users in Ontario (n=77,660). Conclusion: Our findings highlight the rapid uptake of novel agents and a major shift in the treatment of OAB over the last 3 years.

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“…A systematic review of 44 randomized controlled trials involving 27 309 patients showed that mirabegron 50 mg was as efficacious as antimuscarinics in reducing the frequency of micturition and incontinence, but had an incidence of dry mouth and constipation similar to placebo. 18 In a 1-year study, mirabegron and tolterodine extended release (ER) 4 mg were similarly effective, but mirabegron 50 mg had a lower incidence of dry mouth (2.8% vs. 8.6%). 19 In a sub-analysis of patients aged ≥65 years, the incidence of dry mouth after 1 year was 6-fold lower with mirabegron than with tolterodine ER.…”

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

102

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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Comparative Efficacy and Safety of Medical Treatments for the Management of Overactive Bladder: A Systematic Literature Review and Mixed Treatment Comparison

Cited by 232 publications

References 52 publications

Mirabegron as Add-On Treatment to Solifenacin in Patients with Incontinent Overactive Bladder and an Inadequate Response to Solifenacin Monotherapy

Mirabegron as Add-On Treatment to Solifenacin in Patients with Incontinent Overactive Bladder and an Inadequate Response to Solifenacin Monotherapy

Publicly funded overactive bladder drug treatment patterns in Ontario over 15 years: An ecological study

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

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