A retrospective study of treatment persistence and adherence to α-blocker plus antimuscarinic combination therapies, in men with LUTS/BPH in the Netherlands
Identifieur interne : 000388 ( Main/Exploration ); précédent : 000387; suivant : 000389A retrospective study of treatment persistence and adherence to α-blocker plus antimuscarinic combination therapies, in men with LUTS/BPH in the Netherlands
Auteurs : Marcus J. Drake [Royaume-Uni] ; Sally Bowditch [Royaume-Uni] ; Emilio Arbe [Royaume-Uni] ; Zalmai Hakimi [Pays-Bas] ; Florent Guelfucci [Royaume-Uni] ; Ikbel Amri [Tunisie] ; Jameel Nazir [Royaume-Uni]Source :
- BMC Urology [ 1471-2490 ] ; 2017.
Descripteurs français
- KwdFr :
- Adhésion au traitement médicamenteux (statistiques et données numériques), Adulte d'âge moyen (MeSH), Antagonistes alpha-adrénergiques (administration et posologie), Antagonistes muscariniques (administration et posologie), Association de médicaments (MeSH), Humains (MeSH), Hyperplasie de la prostate (complications), Hyperplasie de la prostate (traitement médicamenteux), Mâle (MeSH), Pays-Bas (MeSH), Succinate de solifénacine (administration et posologie), Sujet âgé (MeSH), Symptômes de l'appareil urinaire inférieur (traitement médicamenteux), Symptômes de l'appareil urinaire inférieur (étiologie), Tartrate de toltérodine (administration et posologie), Études de cohortes (MeSH), Études rétrospectives (MeSH).
- MESH :
- administration et posologie : Antagonistes alpha-adrénergiques, Antagonistes muscariniques, Succinate de solifénacine, Tartrate de toltérodine.
- statistiques et données numériques : Adhésion au traitement médicamenteux.
- traitement médicamenteux : Hyperplasie de la prostate, Symptômes de l'appareil urinaire inférieur.
- étiologie : Symptômes de l'appareil urinaire inférieur.
- complications : Adulte d'âge moyen, Association de médicaments, Humains, Hyperplasie de la prostate, Mâle, Pays-Bas, Sujet âgé, Études de cohortes, Études rétrospectives.
English descriptors
- KwdEn :
- Adrenergic alpha-Antagonists (administration & dosage), Aged (MeSH), Cohort Studies (MeSH), Drug Therapy, Combination (MeSH), Humans (MeSH), Lower Urinary Tract Symptoms (drug therapy), Lower Urinary Tract Symptoms (etiology), Male (MeSH), Medication Adherence (statistics & numerical data), Middle Aged (MeSH), Muscarinic Antagonists (administration & dosage), Netherlands (MeSH), Prostatic Hyperplasia (complications), Prostatic Hyperplasia (drug therapy), Retrospective Studies (MeSH), Solifenacin Succinate (administration & dosage), Tolterodine Tartrate (administration & dosage).
- MESH :
- chemical , administration & dosage : Adrenergic alpha-Antagonists, Muscarinic Antagonists, Solifenacin Succinate, Tolterodine Tartrate.
- complications : Prostatic Hyperplasia.
- drug therapy : Lower Urinary Tract Symptoms, Prostatic Hyperplasia.
- etiology : Lower Urinary Tract Symptoms.
- statistics & numerical data : Medication Adherence.
- Aged, Cohort Studies, Drug Therapy, Combination, Humans, Male, Middle Aged, Netherlands, Retrospective Studies.
Abstract
To assess treatment persistence and adherence in men ≥45 years of age with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), using prescription records from the Netherlands IMS Lifelink™ LRx database.
In this retrospective, observational cohort study, we identified men who received combination therapy with an α-blocker plus an antimuscarinic (e.g. solifenacin or tolterodine) between 1 November 2013 and 31 October 2014. Treatment could be received as a fixed-dose combination (FDC) tablet or as two drugs administered together (concomitant therapy), if both combination drugs were prescribed within 30 days. The primary objective was to assess treatment persistence, defined as the time from initiation of combination therapy until first discontinuation of the FDC or at least one of the drugs given concomitantly (i.e. ≥30 days without prescription renewal). Subgroup and sensitivity analyses were conducted to assess persistence by antimuscarinic agent, and with different gap lengths used to define discontinuation (45, 60 and 90 days), respectively.
A total of 1891 men received an α-blocker plus an antimuscarinic (FDC,
This study of real-world evidence of men with LUTS/BPH treated with α-blocker plus antimuscarinic combination therapy in the Netherlands showed that treatment persistence was significantly greater in those who received a FDC tablet compared with combination therapy given concomitantly. The study also shows that treatment persistence was extended in men who received combination therapy containing solifenacin compared with other antimuscarinics.
Overall, these findings may be useful for prescribers, as improved persistence on-treatment may translate into improved outcomes for men with LUTS/BPH. Further study is warranted to establish the key drivers of persistence in men receiving combination therapy for LUTS/BPH.
The online version of this article (doi:10.1186/s12894-017-0226-2) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12894-017-0226-2
PubMed: 28532455
PubMed Central: 5440896
Affiliations:
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Le document en format XML
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<series><title level="j">BMC Urology</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adrenergic alpha-Antagonists (administration & dosage)</term>
<term>Aged (MeSH)</term>
<term>Cohort Studies (MeSH)</term>
<term>Drug Therapy, Combination (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Lower Urinary Tract Symptoms (drug therapy)</term>
<term>Lower Urinary Tract Symptoms (etiology)</term>
<term>Male (MeSH)</term>
<term>Medication Adherence (statistics & numerical data)</term>
<term>Middle Aged (MeSH)</term>
<term>Muscarinic Antagonists (administration & dosage)</term>
<term>Netherlands (MeSH)</term>
<term>Prostatic Hyperplasia (complications)</term>
<term>Prostatic Hyperplasia (drug therapy)</term>
<term>Retrospective Studies (MeSH)</term>
<term>Solifenacin Succinate (administration & dosage)</term>
<term>Tolterodine Tartrate (administration & dosage)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adhésion au traitement médicamenteux (statistiques et données numériques)</term>
<term>Adulte d'âge moyen (MeSH)</term>
<term>Antagonistes alpha-adrénergiques (administration et posologie)</term>
<term>Antagonistes muscariniques (administration et posologie)</term>
<term>Association de médicaments (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Hyperplasie de la prostate (complications)</term>
<term>Hyperplasie de la prostate (traitement médicamenteux)</term>
<term>Mâle (MeSH)</term>
<term>Pays-Bas (MeSH)</term>
<term>Succinate de solifénacine (administration et posologie)</term>
<term>Sujet âgé (MeSH)</term>
<term>Symptômes de l'appareil urinaire inférieur (traitement médicamenteux)</term>
<term>Symptômes de l'appareil urinaire inférieur (étiologie)</term>
<term>Tartrate de toltérodine (administration et posologie)</term>
<term>Études de cohortes (MeSH)</term>
<term>Études rétrospectives (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Adrenergic alpha-Antagonists</term>
<term>Muscarinic Antagonists</term>
<term>Solifenacin Succinate</term>
<term>Tolterodine Tartrate</term>
</keywords>
<keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Antagonistes alpha-adrénergiques</term>
<term>Antagonistes muscariniques</term>
<term>Succinate de solifénacine</term>
<term>Tartrate de toltérodine</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Prostatic Hyperplasia</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Lower Urinary Tract Symptoms</term>
<term>Prostatic Hyperplasia</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lower Urinary Tract Symptoms</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Medication Adherence</term>
</keywords>
<keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Adhésion au traitement médicamenteux</term>
</keywords>
<keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Hyperplasie de la prostate</term>
<term>Symptômes de l'appareil urinaire inférieur</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Symptômes de l'appareil urinaire inférieur</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Cohort Studies</term>
<term>Drug Therapy, Combination</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Netherlands</term>
<term>Retrospective Studies</term>
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<keywords scheme="MESH" qualifier="complications" xml:lang="fr"><term>Adulte d'âge moyen</term>
<term>Association de médicaments</term>
<term>Humains</term>
<term>Hyperplasie de la prostate</term>
<term>Mâle</term>
<term>Pays-Bas</term>
<term>Sujet âgé</term>
<term>Études de cohortes</term>
<term>Études rétrospectives</term>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>To assess treatment persistence and adherence in men ≥45 years of age with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), using prescription records from the Netherlands IMS Lifelink™ LRx database.</p>
</sec>
<sec><title>Methods</title>
<p>In this retrospective, observational cohort study, we identified men who received combination therapy with an α-blocker plus an antimuscarinic (e.g. solifenacin or tolterodine) between 1 November 2013 and 31 October 2014. Treatment could be received as a fixed-dose combination (FDC) tablet or as two drugs administered together (concomitant therapy), if both combination drugs were prescribed within 30 days. The primary objective was to assess treatment persistence, defined as the time from initiation of combination therapy until first discontinuation of the FDC or at least one of the drugs given concomitantly (i.e. ≥30 days without prescription renewal). Subgroup and sensitivity analyses were conducted to assess persistence by antimuscarinic agent, and with different gap lengths used to define discontinuation (45, 60 and 90 days), respectively.</p>
</sec>
<sec><title>Results</title>
<p>A total of 1891 men received an α-blocker plus an antimuscarinic (FDC, <italic>N =</italic>
665; concomitant therapy, <italic>N =</italic>
1226). Median time to discontinuation was significantly longer with FDC versus concomitant therapy (414 vs. 112 days; adjusted hazard ratio [HR] 2.04, 95% confidence interval 1.77, 2.35; <italic>p</italic>
< 0.0001). Persistence at 12 months (51.3% vs. 29.9%) was also significantly greater with FDC compared with concomitant therapy. Assessment of antimuscarinic subgroups showed that median time to discontinuation was longest with solifenacin combinations (214 days) compared with other antimuscarinic combinations (range, 47–164 days; adjusted HR range, 1.27–1.77, <italic>p</italic>
= 0.037). No observable impact on treatment persistence was found by adjusting the gaps used to define discontinuation.</p>
</sec>
<sec><title>Discussion</title>
<p>This study of real-world evidence of men with LUTS/BPH treated with α-blocker plus antimuscarinic combination therapy in the Netherlands showed that treatment persistence was significantly greater in those who received a FDC tablet compared with combination therapy given concomitantly. The study also shows that treatment persistence was extended in men who received combination therapy containing solifenacin compared with other antimuscarinics.</p>
</sec>
<sec><title>Conclusions</title>
<p>Overall, these findings may be useful for prescribers, as improved persistence on-treatment may translate into improved outcomes for men with LUTS/BPH. Further study is warranted to establish the key drivers of persistence in men receiving combination therapy for LUTS/BPH.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12894-017-0226-2) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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