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

Abstract

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.

Initial Experience with Mirabegron for the Treatment of Neurogenic Lower Urinary Tract Dysfunction

“…The β3-adrenergic agonist mirabegron was introduced into the treatment of iOAB in 2012. Its safety and efficacy in the treatment of this condition have been confirmed in a large number of well-designed studies [12]. In this study we also found improvement in the mean volume of per catheterization.…”

“…Clinical trials have demonstrated its efficacy and safety [9] [10] and observational studies suggest improved persistence and adherence when compared to antimuscarinics [11]. As such, it has become a commonly used overactive bladder medication in the general population [12]. But few studies were carried on the treatment of mirabegron for NDO.…”

A pilot randomized‐controlled trial of the urodynamic efficacy of mirabegron for patients with neurogenic lower urinary tract dysfunction

“…Clinical trials have demonstrated its efficacy and safety, and observational studies suggest improved persistence and adherence when compared to antimuscarinics . As such, it has become a commonly used overactive bladder medication in the general population . There is interest in using mirabegron for patients with NLUTD due to the potentially better safety and tolerability profile; however, there is limited evidence of its efficacy in this population .…”

“…7 As such, it has become a commonly used overactive bladder medication in the general population. 8 There is interest in using mirabegron for patients with NLUTD due to the potentially better safety and tolerability profile 5,9 ; however, there is limited evidence of its efficacy in this population. 10,11 There are potentially serious consequences of inadequately treated neurogenic bladder parameters; one study found that almost 20% of SCI patients required surgical invention for adverse urodynamic parameters over a 5-year period.…”

Mirabegron: a decade of study

“…This set in motion an important new therapeutic option for patients with overactive bladder (OAB). Once available for use, mirabegron rapidly became one of the most commonly used oral therapies for OAB (2,3).…”