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

Abstract

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.

Quality of life in patients aged 65 years and older with overactive bladder treated with mirabegron across eight European countries: Secondary analysis of BELIEVE

“…Also in this group of patients, polypharmacy and the cognitive impairment seen with total anticholinergic load are relevant considerations . Retrospective data also show that persistence with mirabegron is higher than that observed with antimuscarinic agents …”

The efficacy and safety of Vibegron in treating overactive bladder: A systematic review and pooled analysis of randomized controlled trials

“…For decades, anticholinergics such as tolterodine, solifencin, fesoterodine, and so on have been the chief pharmacotherapy for OAB. However, it is clinically observed that their usefulness is limited by modest efficacy and lack of bladder specificity, leading to well‐documented side effects including constipation, dry mouth, and dizziness 15,16 . Vibegron (RVT‐901; KRP‐114V) is a new selective β3‐adrenergic receptor agonist, which developed for treating OAB patients 17,18 …”

<p>Evaluating the Effectiveness of an Additional Risk Minimization Measure to Reduce the Risk of Prescribing Mirabegron to Patients with Severe Uncontrolled Hypertension in Four European Countries</p>

“…Fourthly, in order to detect a change in BP monitoring intensity during treatment, regular check-ups are required, but the duration of treatment is often limited. More than 50% of patients have been reported to have stopped treatment after 1 month 29 or after the first prescription 30 (i.e. non-persistence), and after 1 year the supplied amount of mirabegron has been reported to cover <60% of the period.…”

“…non-persistence), and after 1 year the supplied amount of mirabegron has been reported to cover <60% of the period. 29 Alleviation of symptoms is a factor in nonpersistence with treatment for overactive bladder, and intermittent treatment is often observed. 29,30 Therefore, we allowed mirabegron treatment to contain gaps of up to 12 months, with the aim of ensuring that duration of treatment was long enough to allow comparison of quarterly BP monitoring rates before and after DHPC dissemination.…”

“…29 Alleviation of symptoms is a factor in nonpersistence with treatment for overactive bladder, and intermittent treatment is often observed. 29,30 Therefore, we allowed mirabegron treatment to contain gaps of up to 12 months, with the aim of ensuring that duration of treatment was long enough to allow comparison of quarterly BP monitoring rates before and after DHPC dissemination. Multiple post-hoc sensitivity analyses with different periods of follow-up, including as short as 1 month, were performed to assess the impact on results, but none of the analyses yielded a difference in BP monitoring rates before and after the DHPC.…”