Treatment Patterns for Patients on Overactive Bladder Therapy: A Retrospective Statistical Analysis Using Canadian Claims Data

Abstract

Background: Overactive bladder (OAB) is a chronic condition which may be associated with a significant negative impact on quality of life. Antimuscarinic drugs are currently the mainstay of medical therapy, but persistence and adherence are generally poor. Treatment switching may be considered in order to maximise benefits from pharmacological therapy, but there are relatively few data on OAB therapy switching to second and third-lines of medication. There are also few formal analyses on the impact of age, gender and choice of initial OAB drug on discontinuation rates. Objectives: To investigate discontinuation rates with antimuscarinics in patients newly starting OAB therapy, with regard to patterns of switching to alternative medication, and the potential impact of age, gender and choice of initial drug.</p> Methods: Data on prescription drug use in Canada were retrieved from the IMS Brogan public and private prescription claims databases. Medication usage was tracked for four years following an index claim. The primary endpoint was the number of days from index claim to discontinuation of medication. Secondary endpoints were the number of days on first-line therapy before switching. Descriptive results were evaluated using univariate (Kaplan-Meier) and multivariate (Cox proportional hazards) models. Results: Data were available for 31,754 patients. Approximately 91% discontinued OAB medication within the four-year follow-up period. The discontinuation rate was similar between men and women. The risk of discontinuation in patients ≥75 years was only slightly higher than that in patients aged 40−64 years (hazard ratio of 1.08) and was lower than in those aged 65−74 years. Retention when oxybutynin was the initial drug was lower than with most of the other antimuscarinics. Only 12.5% of patients changed OAB medication during the 4-year period. Women were more likely than men to switch from first-line or second-line treatment. Conclusions: Discontinuation of initial antimuscarinic therapy was high. Compared with oxybutynin, several alternative antimuscarinics offered lower risks of discontinuation. The majority of patients had no trial of second-line treatment.

Persistence and adherence with mirabegron vs antimuscarinics in overactive bladder: Retrospective analysis of a UK General Practice prescription database

“…The principal drugs used for treating OAB are antimuscarinics, but persistence with these drugs is known to be generally poor . In the UK, the National Institute for Health and Care Excellence (NICE) currently recommends the use of oxybutynin IR, tolterodine IR, or darifenacin (once‐daily preparation) as first‐line drug therapy in women with OAB or mixed urinary incontinence, and any antimuscarinic in men; similar guidelines are also used in many other countries and jurisdictions.…”

“…These are given to help alleviate urinary urgency, with or without urinary incontinence, increased daytime frequency and nocturia, but their use is frequently associated with adverse effects, especially anticholinergic effects such as dry mouth, constipation and blurred vision . Furthermore, there is generally poor persistence with antimuscarinic therapy . In a UK study, for example, up to 86% of patients with OAB discontinued antimuscarinic therapy after 1 year, and in a long‐term Canadian study of 31 754 patients, approximately 91% discontinued within 4 years .…”

“…Furthermore, there is generally poor persistence with antimuscarinic therapy . In a UK study, for example, up to 86% of patients with OAB discontinued antimuscarinic therapy after 1 year, and in a long‐term Canadian study of 31 754 patients, approximately 91% discontinued within 4 years . In a systematic review of 14 studies (>190 000 patients), which investigated persistence and/or adherence with antimuscarinics in OAB, median persistence across all antimuscarinics ranged from 6.0 to 12.0% at 24 months .…”

Efficacy and safety of combinations of mirabegron and solifenacin compared with monotherapy and placebo in patients with overactive bladder (SYNERGY study)

“…Antimuscarinics and b 3 -adrenoceptor agonists modulate bladder function through different molecular pathways; nevertheless, efficacy is similar for both drug classes [6]. In clinical practice, antimuscarinics are often initially prescribed; however, increasing the dose may exacerbate antimuscarinic adverse events (AEs) such as dry mouth and constipation, which may result in treatment discontinuation [7][8][9][10]. Analyses of medical claims databases indicate that treatment persistence is better with mirabegron vs antimuscarinics [11][12][13].…”

Overactive bladder: strategies to ensure treatment compliance and adherence

“… 28 Similar results were also found in Canadian patients with OAB aged ≥66 years, in which the 2-year withdrawal rates from oxybutynin (n=31,996) and tolterodine (n=24,855) were 91% and 86%, respectively. 29 , 30 This study did not find any difference in the persistence rates between males and females but did not find an age-related improvement in treatment persistence; though older patients were, in general, no more likely to discontinue their treatment than younger patients.…”