Comparative Efficacy and Tolerability of Antimuscarinic Agents and the Selective β3‐Adrenoceptor Agonist, Mirabegron, for the Treatment of Overactive Bladder: Which is More Preferable as an Initial Treatment?

Kobayashi, Minoru; Nukui, Akinori; Kamai, Takao

doi:10.1111/luts.12153

Cited by 9 publications

(7 citation statements)

References 27 publications

(69 reference statements)

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“… 33 In addition, 28% and 60% of patients switched to another drug following initial treatment with mirabegron or antimuscarinics in a small 8‐week Japanese prospective study. 39 Similar findings were observed in a 48‐month prospective study, which found that 60.8% of patients switched from solifenacin to mirabegron therapy. 40 …”

Section: Discussionsupporting

confidence: 79%

“…For example, in a large retrospective US database analysis, a total of 14% and 4% of the patients who received treatment with mirabegron or an anticholinergic, respectively, switched treatment during a 12‐month follow‐up period 33 . In addition, 28% and 60% of patients switched to another drug following initial treatment with mirabegron or antimuscarinics in a small 8‐week Japanese prospective study 39 . Similar findings were observed in a 48‐month prospective study, which found that 60.8% of patients switched from solifenacin to mirabegron therapy 40 …”

Section: Discussionmentioning

confidence: 99%

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

Carlson

Nair

Deal³

et al. 2021

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Objectives This analysis from the PERSPECTIVE (a Prospective, Non‐interventional Registry Study of Patients Initiating a Course of Drug Therapy for Overactive Bladder) study evaluated treatment persistence with mirabegron or antimuscarinics over a 12‐month period. Methods Participants were adults diagnosed with overactive bladder (OAB) by their health care provider (HCP), who were initiating mirabegron or antimuscarinic treatment. The HCP made all treatment decisions, and patients were followed for 12 months with no mandatory scheduled visits. Information requests were sent to patients at baseline and months 1, 3, 6, and 12. Patients were nonpersistent if they switched, discontinued, or added OAB medications/therapies to their initial treatment. Reasons for discontinuation and switching patterns were investigated. Results Overall, 1514 patients were included (613 mirabegron and 901 antimuscarinic initiators). Persistence rates decreased steadily over time in both groups. A low proportion of patients added or switched medication at each time point. Unadjusted Kaplan‐Meier analysis showed similar persistence rates for both groups. When the data were adjusted for patient characteristics (age, sex, and OAB treatment status), mirabegron initiators had higher persistence rates. No significant differences were noted in unadjusted median time to end of persistence. However, end of treatment persistence by any cause was longer with mirabegron (median: 9.5 vs 6.7 months for antimuscarinics). HCPs stated that the most common reasons for nonpersistence were no symptomatic improvement and side effect aversion. Conclusions Treatment persistence was longer for mirabegron compared with antimuscarinic initiators after controlling for patient characteristics. End of treatment persistence by any cause was also longer with mirabegron.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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

Carlson

Nair

Deal³

et al. 2021

LUTS

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“…21–23 Due to mirabegron’s mechanism of action, the incidence of side effects typically reported with antimuscarinic treatment are low with mirabegron and generally similar to placebo, 24 which may translate into better treatment persistence. 25 26 In addition, results of a recent economic analysis found that increased persistence with mirabegron treatment versus antimuscarinics was associated with reduced healthcare resource use and work hours lost, resulting in lower total costs. 27 …”

Section: Introductionmentioning

confidence: 99%

Real-world persistence and adherence to oral antimuscarinics and mirabegron in patients with overactive bladder (OAB): a systematic literature review

et al. 2018

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PurposeTo evaluate persistence and adherence of oral pharmacotherapy used in the treatment of overactive bladder (OAB) in a real-world setting.Materials and methodsSystematic literature searches of six electronic publication databases were performed to identify observational studies of patients with OAB treated with antimuscarinics and/or mirabegron. Studies obtaining persistence and adherence data from sources other than electronic prescription claims were excluded. Reference lists of identified studies and relevant systematic reviews were assessed to identify additional relevant studies.ResultsThe search identified 3897 studies, of which 30 were included. Overall, persistence ranged from 5% to 47%. In studies reporting data for antimuscarinics and mirabegron (n=3), 1-year persistence was 12%–25% and 32%–38%, respectively. Median time to discontinuation was <5 months for antimuscarinics (except one study (6.5 months)) and 5.6–7.4 months for mirabegron. The proportion of patients adherent at 1 year varied between 15% and 44%. In studies reporting adherence for antimuscarinics and mirabegron, adherence was higher with mirabegron (mean medication possession ratio (MPR): 0.59 vs 0.41–0.53; mean proportion of days covered: 0.66 vs 0.55; and median MPR: 0.65 vs 0.19–0.49). Reported determinants of persistence and adherence included female (sex), older age group, use of extended-release formulation and treatment experience.ConclusionMost patients with OAB discontinued oral OAB pharmacotherapy and were non-adherent 1 year after treatment initiation. In general, mirabegron was associated with greater persistence and adherence compared with antimuscarinics. Combined with existing clinical trial evidence, this real-world review merits consideration of mirabegron for first-line pharmacological treatment among patients with OAB.PROSPERO registration numberCRD42017059894.

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“…Clinical guidelines generally recommend antimuscarinic agents and behavioral therapy as the mainstay treatments for OAB . Furthermore, several studies have reported that mirabegron is not only efficacious in the improvement of UUI symptoms, but also has very few side effects . However, current guidelines offer no advice regarding the length of time for which medication should be offered to OAB patients.…”

Section: Discussionmentioning

confidence: 99%

Higher urge severity score predicts resumption of overactive bladder (OAB) medication following discontinuation of mirabegron treatment in patients with OAB

Wang

Jiang

Kuo

2018

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Objectives: This study investigated factors predicting the resumption of mirabegron following its discontinuation with successful treatment of overactive bladder (OAB).Methods: In all, 374 OAB patients reporting an improvement in subjective symptoms after a minimum of 3 months treatment with mirabegron 25 mg, q.d., were screened. Those wanting to continue with the medication (n = 109) were excluded from the study. The remaining 265 patients discontinued mirabegron and their outcomes were evaluated at baseline (discontinuation) and 1, 3, 6, 9, and 12 months using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Urgency Severity Scale (USS), Patient's Perception of Bladder Condition (PPBC), and Global Response Assessment (GRA), as well as uroflowmetry and post-void residual (PVR).Results: After mirabegron discontinuation, 203 patients completed follow-up. The mean (AESD) duration from discontinuing medication to resumption of mirabegron was 2.25 AE 1.17 months (range 1-12 months). Compared with the 111 (54.7%) patients who did not resume mirabegron, the 92 (45.3%) patients who resumed mirabegron had a higher USS at time of discontinuation (1.18 ± 1.76 vs. 0.65 ± 1.33; P = 0.017). The USS was a strong predictor of mirabegron resumption (P = 0.02; odds ratio 1.315; 95% confidence interval 1.051-1.646).Conclusions: Among OAB patients who were successfully treated with mirabegron for ≥3 months, nearly half requested resumption of mirabegron after discontinuation. A higher USS was found to predict retreatment after discontinuation of mirabegron in OAB patients. K E Y W O R D Sdiscontinuation, mirabegron, overactive bladder

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Comparative Efficacy and Tolerability of Antimuscarinic Agents and the Selective β3‐Adrenoceptor Agonist, Mirabegron, for the Treatment of Overactive Bladder: Which is More Preferable as an Initial Treatment?

Abstract: The present study suggests that mirabegron seems to have priority as an initial therapy with a distinct efficacy/tolerability balance. Mirabegron also represents a reasonable alternative to antimuscarinics for patients who had insufficient efficacy and poor tolerability.

Cited by 9 publications

References 27 publications

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

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

Real-world persistence and adherence to oral antimuscarinics and mirabegron in patients with overactive bladder (OAB): a systematic literature review

Higher urge severity score predicts resumption of overactive bladder (OAB) medication following discontinuation of mirabegron treatment in patients with OAB

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