Adherence and persistence of mirabegron and anticholinergic therapies in patients with overactive bladder: a real-world claims data analysis

Abstract

Background: Adherence and persistence rates of anticholinergic (ACH) therapies have been well described. To date, few studies describe these metrics for mirabegron in patients with overactive bladder. Methods: This retrospective analysis of MarketScan â database assessed adherence and persistence of patients receiving either mirabegron or ACH. Study eligibility required an index date (first prescription filled) between July 2012 and June 2013 with 12 months of continuous enrolment preindex date and 12 months of follow-up. Adherence was defined as a proportion of days covered of ≥ 80% among patients with at least 2 fills of index medication. Persistence measures included treatment failure described as either treatment discontinuation (medication supply gap ≥ 30 days) or switching to a different medication. A medication supply gap of ≥ 45 days was used as a sensitivity analysis. Results: The mean age of mirabegron users (n = 4037) was 67 years and 43% were ACH na€ ıve while the mean age of ACH users was 62 years (n = 67,943). Over the 12-month follow-up period, 44% of patients treated with mirabegron and 31% of patients treated with ACH were adherent to their indexed medications. Treatment failure was 81% for mirabegron and 88% for ACH. Most mirabegron treatment failures were because of treatment discontinuation (67%) versus switching to ACH therapy (14%). The ACH discontinuation rate was 84% and treatment switching rate was 4%. The mean (standard deviation) time to treatment failure was 143 (130) days for mirabegron and 69 (69) days for ACH. Adherence and persistence patterns were similar in the sensitivity analysis using a ≥ 45-day supply gap threshold. Conclusions: This real-world study demonstrated low adherence and persistence to mirabegron similar to ACH therapies.

Long‐term persistence with mirabegron in a real‐world clinical setting

“…[13][14][15][16][17][18][19] A smallscaled study at a urology clinic reported a low persistence rate with mirabegron (12.2%; n = 76) and solifenacin (20.1%; n = 72). [13][14][15][16][17][18][19] A smallscaled study at a urology clinic reported a low persistence rate with mirabegron (12.2%; n = 76) and solifenacin (20.1%; n = 72).…”

“…[13][14][15][16][17][18][19] A smallscaled study at a urology clinic reported a low persistence rate with mirabegron (12.2%; n = 76) and solifenacin (20.1%; n = 72). [15][16][17] Single or multicenter clinical studies including hundreds of patients showed better persistence rates ranging from 63% to 71%. [15][16][17] Single or multicenter clinical studies including hundreds of patients showed better persistence rates ranging from 63% to 71%.…”

“…[15][16][17] Single or multicenter clinical studies including hundreds of patients showed better persistence rates ranging from 63% to 71%. [15][16][17] Patients should recognize the chronic nature of OAB and the need for long-term treatment, and medical specialists for LUTD should counsel patients adequately to take medicines for a long time. In the studies using clinical databases, not only urologists and urogynecologists, but also general practitioners, might be included as prescribing doctors.…”

One‐year results with selective bladder denervation in women with refractory overactive bladder

“…However, as patients progress from conservative to pharmacological to third‐line management, the proportion of wet patients with OAB increases such that the vast majority of patients seeking treatment for refractory OAB suffer from urgency urinary incontinence (UUI) . Unfortunately, the persistence rate for pharmacological therapy is poor with roughly two‐thirds of patients discontinuing therapy within 1‐year . As awareness of OAB grows and more patients are treated with medical therapy, given the poor persistence of such therapy, the prevalence of refractory OAB is increasing.…”

Initial clinical experience with selective bladder denervation for refractory overactive bladder

“…Oral therapies are second‐line treatment options if conservative management fails to provide satisfactory symptom relief. Unfortunately, most patients eventually discontinue therapy with antimuscarinics and beta‐3 agonists due to dissatisfaction with treatment response or intolerance of side effects . In patients whose symptoms are refractory to oral therapy, several third‐line treatment options may be considered including botulinum toxin A (BTA) injections, sacral neuromodulation, and percutaneous tibial nerve stimulation (PTNS), all of which provide therapeutic benefit .…”