Low persistence of anticholinergic drug use in Sweden

Linnér, Love; Schiöler, Helena; Samuelsson, Eva; Milsom, Ian; Nilsson, Fredrik

doi:10.1007/s00228-010-0917-z

“…Meta-analyses have shown similar efficacy to available anticholinergic drugs, but with a much reduced incidence of dry mouth 138,139 , and lower efficacy than intravesical onabotulinumtoxinA 140 . Mirabegron has the potential to exacerbate hypertension 131 , but is otherwise well tolerated compared with most anticholinergics, with good persistence 141 . However, for most patients, symptom improvement is quite modest.…”

Section: Managementmentioning

confidence: 99%

Urinary incontinence in women

Aoki

¹

,

Brown

²

,

Brubaker

³

et al. 2017

Nat Rev Dis Primers

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Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.

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“…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%

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

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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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“…All available drugs cause typical cholinergic adverse effects, including dry mouth, constipation, blurred vision, somnolence and confusion [127][128][129] (TABLE 1). Owing to adverse effects, costs and inconvenience, adherence to treatment is often poor [130][131][132] .…”

Section: Medical Interventionsmentioning

confidence: 99%

“…Metaanalyses have shown similar efficacy to available anticholinergic drugs, but with a much reduced incidence of dry mouth 138,139 , and lower efficacy than intravesical onabotulinumtoxinA 140 . Mirabegron has the potential to exacerbate hypertension 131 , but is otherwise well tolerated compared with most anticholinergics, with good persistence 141 . However, for most patients, symptom improvement is quite modest.…”

Section: Medical Interventionsmentioning

confidence: 99%

“…All available drugs cause typical cholinergic adverse effects, including dry mouth, constipation, blurred vision, somnolence and confusion [127][128][129] (TABLE 1). Owing to adverse effects, costs and inconvenience, adherence to treatment is often poor [130][131][132] .Oxybutynin was the first drug with level 1 evidence of efficacy and is sometimes still recommended as a first choice, despite its poor adverse-effect profile 76 . All newer anticholinergic medications for overactive bladder syndrome have been compared in RCTs against both placebo and oxybutynin as a condition of licensing.…”

mentioning

confidence: 99%

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Urinary incontinence in women

Ss

¹

,

Rm²

2017

Nat Rev Dis Primers

15

0

1

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Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.Correspondence to R.C. Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK. r.cartwright@imperial.ac.uk. Author contributions Competing interestsThe authors declare no competing interests. Publisher's noteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. HHS Public AccessAuthor manuscript Nat Rev Dis Primers. Author manuscript; available in PMC 2018 April 01. Published in final edited form as:Nat Rev Dis Primers. ; 3: 17042. doi:10.1038/nrdp.2017.42. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptUrinary incontinence is the complaint of involuntary loss (leakage) of urine 1 . The condition occurs in both sexes, but is much more frequent in women. Although some overlap in pathophysiology is evident between sexes, incontinence in men is often a consequence of prostatic enlargement or from damage to continence mechanisms during surgery or radiotherapy for prostate cancer. By contrast, incontinence in women is typically related to dysfunction of the bladder or pelvic floor muscles, with such dysfunction often arising during pregnancy or childbirth, or at the time of menopause. This Primer focuses on female urinary incontinence because of its higher prevalence and unique pathophysiology.There are two main subtypes of urinary incontinence: stress incontinence and urgency incontinence. According to the International Urogynecological Association (IUGA) and the International Continence Society (ICS) standard definition, stress incontinence is the complaint of urine leakage in association with coughing, sneezing or physical exertion, whereas urgency incontinence is the comp...

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Low persistence of anticholinergic drug use in Sweden

Cited by 18 publications

References 8 publications

Urinary incontinence in women

Urinary incontinence in women

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

Urinary incontinence in women

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