Persistence and adherence in the treatment of overactive bladder syndrome with anticholinergic therapy: a systematic review of the literature

Abstract

Overactive bladder syndrome (OAB) is a chronic condition that has an impact on patients' daily activities and health-related quality of life (HRQL). Anticholinergic therapy is often prescribed following insufficient results with behaviour modification alone; however, rates of treatment discontinuation are consistently high. This study systematically reviewed persistence and adherence data in patients with OAB treated with anticholinergic therapy. A search focused on the intersection of OAB, persistence/adherence, and anticholinergic therapy was conducted in MEDLINE and EMBASE. Articles published after 1998 were reviewed and selected for inclusion based on prespecified criteria. A total of 147 articles and two abstracts were included in the review. Results from 12-week clinical trials showed high rates of discontinuation, ranging from 4% to 31% and 5% to 20% in treatment and placebo groups, respectively. Unsurprisingly, rates of discontinuation found in medical claims studies were substantially higher, with 43% to 83% of patients discontinuing medication within the first 30 days and rates continuing to rise over time. Findings from medical claims studies also suggest that over half of patients never refill their initial prescription and that adherence levels tend to be low, with mean/median medication possession ratio (MPR) values ranging from 0.30 to 0.83. The low levels of persistence and adherence documented in this review reveal cause for concern about the balance between the efficacy and tolerability of anticholinergic agents. Strategies should be identified to increase persistence and adherence. New agents and non-pharmacologic alternatives with good efficacy and minimal side effects should be explored.

Cost-effectiveness of solifenacin compared with oral antimuscarinic agents for the treatment of patients with overactive bladder in the UK

“…Hence, the assumption that AEs are a key contributor to treatment discontinuation had an important role in our model. This assumption is supported by the literature, which shows that the most common reasons for discontinuing antimuscarinics are that treatment did not work as expected and side effects [35]. Further, better persistence rates with solifenacin compared with other commonly prescribed antimuscarinics have been observed in routine clinical practice in the UK and are consistent with our model predictions [24,36].…”

Mirabegron as Add-On Treatment to Solifenacin in Patients with Incontinent Overactive Bladder and an Inadequate Response to Solifenacin Monotherapy

“…This may increase the anticholinergic burden, the risk of bothersome side effects and treatment discontinuation. 13 Other patients may be switched to an alternative antimuscarinic or mirabegron. Those who do not meet their treatment goal with medical therapy are potential candidates for intravesical onabotulinumtoxinA, an invasive treatment that may require intermittent self-catheterization and is often characterized by a fluctuating response over time, and urinary tract infection.…”

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

“…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.…”