Long-Term Adherence to Antimuscarinic Therapy in Everyday Practice: A Systematic Review

Veenboer, Paul W.; Bosch, J. J. van der Werff ten

doi:10.1016/j.juro.2013.10.046

Cited by 141 publications

(121 citation statements)

References 18 publications

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“…Younger age as a risk factor for discontinuation has also been reported elsewhere, 11,12 though this may be a confounder as younger patients generally tend to take fewer prescription medications.…”

Section: Discussionmentioning

confidence: 62%

“…6 The principal drugs used for OAB are antimuscarinic agents. Unfortunately there is a high rate of discontinuation from these drugs, [7][8][9][10][11][12][13] with up to 86% of patients in a UK study stopping therapy after 1 year. 12 In a Canadian study of 31 754 patients with OAB who were treated with antimuscarinics, about 91% discontinued within a 4-year follow-up, and most did not have second-line treatment.…”

Section: Introductionmentioning

confidence: 99%

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Persistence and adherence with the new beta-3 receptor agonist, mirabegron, versus antimuscarinics in overactive bladder: Early experience in Canada

Wagg¹,

Franks²,

Ramos³

et al. 2015

CUAJ

104

132

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Introduction: Antimuscarinics are the principal pharmacological treatment for overactive bladder (OAB), but frequently give rise to anticholinergic side effects, such as dry mouth, a factor leading to poor persistence. The ß 3 -adrenoceptor agonist mirabegron is devoid of significant anticholinergic activity, while being effective in OAB. We evaluated persistence and adherence with mirabegron versus antimuscarinics over 12 months. Methods: We obtained retrospective claims from a Canadian Private Drug Plan database for patients 18 years old and over, with a first claim for mirabegron or antimuscarinics during a 6-month index period (April-September 2013). A 6-month look-back identified those with no prior claims for OAB medication (treatmentnaïve) or ≥1 prior OAB drug (treatment-experienced). Time to end of persistence (≥30 day therapy gap or switch of therapy) was evaluated over 12 months; adherence with medication (medication possession ratio) was also measured. Results: Persistence data from 19 485 patients (74% female, 92% naïve, 19.9% aged ≥65 years) showed that for experienced patients the median number of days on mirabegron was 299 days, compared with a range of 96 to 242 days for the different antimuscarinics; for naïve patients, it was 196 versus 70 to 100 days, respectively. Persistence at 12 months was for mirabegron 39% versus 14% to 35% for antimuscarinics, (experienced) and 30% mirabegron versus 14% to 21% antimuscarinics, (naïve). Patients taking mirabegron demonstrated statistically significantly greater adherence than those taking antimuscarinics. Conclusion: Patients who received mirabegron remained longer on treatment than those treated with antimuscarinics, and had higher 12-month persistence and adherence rates.

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Persistence and adherence with the new beta-3 receptor agonist, mirabegron, versus antimuscarinics in overactive bladder: Early experience in Canada

Wagg¹,

Franks²,

Ramos³

et al. 2015

CUAJ

104

132

View full text Add to dashboard Cite

show abstract

“…In a systematic review, the compliance rate to treatment rate was found to range between 12.0 and 39.4 percent. [16] The most common reasons for withdrawal were side effects, and insufficient efficacy. However, in the current survey, approximately three fourths of all participants reported higher incidence of the side effects as the most important reason.…”

Section: Discussionmentioning

confidence: 99%

The attitudes of Urologists and Gynecologists about overactive bladder and treatment of it in Turkey: A questionnaire survey

Çoşkun

Bayrak

Dinçer

et al. 2017

Turkish Journal of Urology

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Objective: We aimed to review the approaches of urologist and gynecologist in the management of overactive bladder (OAB). Material and methods:A questionnaire consisting of 12 items were answered by 375 urologist and 46 gynecologist. The differences between frequency of encountering OAB, their viewpoints concerning conservative treatment, and their experience related to anticholinergic drug use and the management of refractory OAB were compared. Results:The majority of the urologists, and gynecologists responded to the question "How often do you encounter OAB patients in your daily practice?" as 'in 10-25, and 50% of our patients', respectively (<0.001). The most common complaint consulted to urologists, and gynecologists were urge incontinence (51.1% vs. 64.8). The frequency of using questionnaire and voiding diary was similar in both specialties (23.9% vs. 25.1%, p= 0.892). It was observed that 38.6% of the urologists, and 50% of the gynecologists had recommended conservative treatment as a first-line treatment of overactive bladder (p= 0.049). The low sociocultural level was the most important obstacle confronting application of conservative treatment methods (54.3% vs. 37%, p= 0.012). The survey participants indicated that the most important factor which affected their decision to select an anticholinergic agent as the first-line treatment of overactive bladder was higher effectiveness of these drugs (urologists; 55.7%, and gynecologists 64%, p= 0.371). The patients who started to receive anticholinergic drugs most frequently complained both to their urologists, and/or gynecologists about dry mouth (76.3 vs. 74.5%). Based on the responses of the urologists, and gynecologists, the most frequent reason of anticholinergic drug withdrawal was patients' inability to tolerate side effects of these drugs (48% vs. 47.8%, p= 0.697). The participants indicated that in case of unsatisfactory response to one anticholinergic agent, swithching rate to another anticholinergic drug was 56.9% among urologists vs. 59.6%, among gynecologists. In addition, 36.9% of urologists and 38.5% of gynecologists recommended another pharmaceutical form of the drug with a higher dose to their patients (p=0.279). Similar number of physicians indicated that the prescribed anticholinergic drug should be continued for at least 3 months and in case of unresponsiveness patient could be considered refractory. Majority of urologists (68.8%), and gynecologists (56.5%) chose to perform urodynamic tests in patients who are unresponsive to anticholinergic treatment, (p= 0.093). Conclusion:The attitudes of urologist and gynecologist for diagnosis and treatment of OAB are mostly correlating with current guideline practices with few exceptions. Urologists tend to use bladder diaries or questionnaires less frequently whereas, gynecologists refer to urodynamic studies in patients with refractory OAB less than the urologists do. However, irrespective of the clinical speciality, conservative treatment modalities are rarely administered.

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“…6 A systematic review of 14 studies of people with OAB found median persistence rates with antimuscarinic drugs ranged between 12% and 39% at 12 months, falling to between 6% and 12% at 24 months. 7 Rates of non-adherence and discontinuation of treatment for OAB are reportedly the same for men and women. 8 …”

Section: Adherence In Urologymentioning

confidence: 96%

Improving adherence in urological conditions

Kenny¹

2017

Trends Urol & Men's Health

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Long-Term Adherence to Antimuscarinic Therapy in Everyday Practice: A Systematic Review

Abstract: Improvement in adherence and persistence with antimuscarinic medication should be an important goal in the development of new drugs for overactive bladder and urinary incontinence.

Cited by 141 publications

References 18 publications

Persistence and adherence with the new beta-3 receptor agonist, mirabegron, versus antimuscarinics in overactive bladder: Early experience in Canada

Persistence and adherence with the new beta-3 receptor agonist, mirabegron, versus antimuscarinics in overactive bladder: Early experience in Canada

The attitudes of Urologists and Gynecologists about overactive bladder and treatment of it in Turkey: A questionnaire survey

Improving adherence in urological conditions

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