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Platinum Priority – Incontinence
Editorial by XXX on pp. x–y of this issue

Persistence and Adherence with Mirabegron versus Antimuscarinic Agents in Patients with Overactive Bladder: A Retrospective Observational Study in UK Clinical Practice

By: Christopher R. Chapplea , Jameel Nazirb, Zalmai Hakimic, Sally Bowditchb, Francis Fatoyed, Florent Guelfuccie, Amine Khemirif, Emad Siddiquib and Adrian Waggg

European Urology, February 2017

Published online: 23 February 2017

Keywords: Adherence, Antimuscarinics, Mirabegron, Observational, Overactive bladder, Persistence

Abstract Full Text Full Text PDF (735 KB)

Abstract

Background

Persistence with antimuscarinic therapy in overactive bladder (OAB) is poor, but may be different for mirabegron, a β3-adrenoceptor agonist with a different adverse event profile.

Objective

To compare persistence and adherence with mirabegron versus tolterodine extended release (ER) and other antimuscarinics in routine clinical practice over a 12-mo period.

Design, setting, and participants

Retrospective, longitudinal, observational study of anonymised data from the UK Clinical Practice Research Datalink GOLD database. Eligibility: age ≥18 yr, ≥1 prescription for target OAB drug (between May 1, 2013 and June 29, 2014), and 12-mo continuous enrolment before and after the index prescription date.

Interventions

Mirabegron, darifenacin, fesoterodine, flavoxate, oxybutynin ER or immediate-release (IR), propiverine, solifenacin, tolterodine ER or IR, and trospium chloride.

Outcome measurements and statistical analysis

The primary endpoint was persistence (time to discontinuation). Secondary endpoints included 12-mo persistence rates and adherence (assessed using medication possession ratio, MPR). Cox proportional-hazards regression models and logistic regression models adjusted for potential confounding factors were used to compare cohorts. Analyses were repeated after 1:1 matching.

Results and limitations

The study population included 21 996 eligible patients. In the unmatched analysis, the median time-to-discontinuation was significantly longer for mirabegron (169 d, interquartile range [IQR] 41–not reached) compared to tolterodine ER (56 d, IQR 28–254; adjusted hazard ratio [HR] 1.55, 95% confidence interval 1.41–1.71; p < 0.0001) and other antimuscarinics (range 30–78 d; adjusted HR range 1.24–2.26, p < 0.0001 for all comparisons). The 12-mo persistence rates and MPR were also significantly greater with mirabegron than with all the antimuscarinics. Limitations include the retrospective design, use of prescription records to estimate outcomes, and inability to capture reasons for discontinuation.

Conclusions

Persistence and adherence were statistically significantly greater with mirabegron than with tolterodine ER and other antimuscarinics prescribed for OAB in the UK.

Patient summary

This study assessed persistence and adherence (or compliance) with medications prescribed for OAB in a large UK population. We found that patients prescribed mirabegron remained on treatment for longer and showed greater adherence than those prescribed traditional antimuscarinics.

Take Home Message

For chronic conditions such as overactive bladder, long-term adherence is important to maintain treatment benefit. Persistence with antimuscarinics is a recognised challenge. This analysis of a UK primary care database demonstrates that persistence and adherence are significantly greater with mirabegron versus antimuscarinics.

Keywords: Adherence, Antimuscarinics, Mirabegron, Observational, Overactive bladder, Persistence.

Footnotes

a Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK

b Astellas Pharma Europe Ltd., Astellas Medical Affairs, EMEA, HEOR, Chertsey, UK

c Astellas Pharma Europe B.V., Astellas Medical Affairs, Global, HEOR, Leiden, Netherlands

d Department of Health Professions, Manchester Metropolitan University, Manchester, UK

e Creativ-Ceutical, Paris, France

f Creativ-Ceutical SARL, Les Berges du lac, Tunisia

g Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Corresponding author. Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK. Tel. +44 114 2713048; Fax: +44 114 2797841.

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