Real life persistence rate with antimuscarinic treatment in patients with idiopathic or neurogenic overactive bladder: a prospective cohort study with solifenacin

Abstract

BackgroundSeveral studies have shown that the antimuscarinic treatment of overactive bladder is characterized by low long-term persistence rates. We have investigated the persistence of solifenacin in real life by means of telephonic interviews in a prospective cohort. We included both patients with idiopathic overactive bladder as well as neurogenic overactive bladder.MethodsFrom June 2009 until July 2012 patients with idiopathic or neurogenic overactive bladder who were newly prescribed solifenacin were included. In total 123 subjects were followed prospectively during one year by means of four telephonic interviews, which included questions about medication use and adverse events.ResultsAfter one year 40% of all patients included was still using solifenacin, 50% discontinued and 10% was lost to follow-up. In the neurogenic group 58% was still using solifenacin versus 32% in the idiopathic group after one year (p < 0,05). The main reasons to stop solifenacin were lack of efficacy, side effects and a combination of both.ConclusionsThis prospective cohort study showed a real life continuation rate of 40% after 12 months. This continuation rate is higher than found in most other studies.The use of regular telephonic evaluation might have improved medication persistence. The findings of this study also suggest that patients with neurogenic overactive bladder have a better persistence with this method of evaluation compared to patients with idiopathic overactive bladder.Trial registrationThis study was retrospectively registered on march 17, 2017 at the ISRCTN registry with study ID ISRCTN13129226.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-017-0216-4) contains supplementary material, which is available to authorized users.

Real life data on mirabegron in neurogenic bladder dysfunction

“…The most frequent reason for discontinuation was lack of effect and side effects. Both of these characteristics were similar to antimuscarinic treatment [4,15].…”

“…Patients enrolled in this study have neurogenic etiology, which frequently necessitates concomitant medications with varying anticholinergic effect. Longerterm clinical data has shown that anticholinergics initially alleviate symptoms; however, a subset of patients subsequently discontinue with lack of efficacy being the most frequent reason [4]. In elegant animal studies, chronic administration of anticholinergics show similar initial re-duction in voids, which normalized at 4 weeks along with reduced expression of M3 receptors [16,17].…”

“…ANLUTD underlying these symptoms is mainly treated with antimuscarinics [3]. These agents have high discontinuation rates in idiopathic overactive bladder as well as neurogenic etiology, 57.8% and 32.5% at 1 year, respectively [4]. Mirabegron is the first beta-3 agonist that has been approved since 2013 as treatment for overactive bladder [5].…”

Efficacy and safety of mirabegron for the treatment of neurogenic detrusor overactivity resulting from traumatic spinal cord injury: A prospective study

“…However, the majority of the randomized‐controlled trials (RCTs) indicate that with antimuscarinics treatment, only a small proportion (30%–40%) of the patients become dry 4 . Furthermore, a substantial proportion of the patients (39%) do not respond adequately to antimuscarinic treatment even at high doses 5,6 . Botulinum toxin is the standard second‐line option in patients with NDO refractory to antimuscarinics.…”

Efficacy and safety of mirabegron for the treatment of low compliance bladder resulting from sacral/infrasacral lesions: A prospective study

“…However, much of the data on antimuscarinics and its role in improving capacity, decreasing detrusor pressure, and improving compliance comes from neurogenic bladder patients who had NDO, and very few series have examined the role of antimuscarinics in patients with low compliance bladders resulting from sacral/infrasacral lesions 7 . Furthermore, moderate‐to‐low efficacy, with a significant proportion of patients continuing to be in the “danger zone,” along with occasional poor tolerability, limit the patient’s adherence to drug therapy 7,8 . Current alternatives to improve compliance include invasive therapies with their attendant risks.…”