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Persistence and Adherence with Mirabegron versus Antimuscarinic Agents in Patients with Overactive Bladder: A Retrospective Observational Study in UK Clinical Practice.

Identifieur interne : 000450 ( PubMed/Corpus ); précédent : 000449; suivant : 000451

Persistence and Adherence with Mirabegron versus Antimuscarinic Agents in Patients with Overactive Bladder: A Retrospective Observational Study in UK Clinical Practice.

Auteurs : Christopher R. Chapple ; Jameel Nazir ; Zalmai Hakimi ; Sally Bowditch ; Francis Fatoye ; Florent Guelfucci ; Amine Khemiri ; Emad Siddiqui ; Adrian Wagg

Source :

RBID : pubmed:28196724

English descriptors

Abstract

BACKGROUND

Persistence with antimuscarinic therapy in overactive bladder (OAB) is poor, but may be different for mirabegron, a β

OBJECTIVE

To compare persistence and adherence with mirabegron versus tolterodine extended release (ER) and other antimuscarinics in routine clinical practice over a 12-mo period.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective, longitudinal, observational study of anonymised data from the UK Clinical Practice Research Datalink GOLD database. Eligibility: age ≥18 yr, ≥1 prescription for target OAB drug (between May 1, 2013 and June 29, 2014), and 12-mo continuous enrolment before and after the index prescription date.

INTERVENTIONS

Mirabegron, darifenacin, fesoterodine, flavoxate, oxybutynin ER or immediate-release (IR), propiverine, solifenacin, tolterodine ER or IR, and trospium chloride.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The primary endpoint was persistence (time to discontinuation). Secondary endpoints included 12-mo persistence rates and adherence (assessed using medication possession ratio, MPR). Cox proportional-hazards regression models and logistic regression models adjusted for potential confounding factors were used to compare cohorts. Analyses were repeated after 1:1 matching.

RESULTS AND LIMITATIONS

The study population included 21996 eligible patients. In the unmatched analysis, the median time-to-discontinuation was significantly longer for mirabegron (169 d, interquartile range [IQR] 41-not reached) compared to tolterodine ER (56 d, IQR 28-254; adjusted hazard ratio [HR] 1.55, 95% confidence interval 1.41-1.71; p<0.0001) and other antimuscarinics (range 30-78 d; adjusted HR range 1.24-2.26, p<0.0001 for all comparisons). The 12-mo persistence rates and MPR were also significantly greater with mirabegron than with all the antimuscarinics. Limitations include the retrospective design, use of prescription records to estimate outcomes, and inability to capture reasons for discontinuation.

CONCLUSIONS

Persistence and adherence were statistically significantly greater with mirabegron than with tolterodine ER and other antimuscarinics prescribed for OAB in the UK.

PATIENT SUMMARY

This study assessed persistence and adherence (or compliance) with medications prescribed for OAB in a large UK population. We found that patients prescribed mirabegron remained on treatment for longer and showed greater adherence than those prescribed traditional antimuscarinics.


DOI: 10.1016/j.eururo.2017.01.037
PubMed: 28196724

Links to Exploration step

pubmed:28196724

Le document en format XML

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<term>Adrenergic beta-3 Receptor Agonists (adverse effects)</term>
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<term>Aged (MeSH)</term>
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<term>Urinary Bladder, Overactive (drug therapy)</term>
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<front>
<div type="abstract" xml:lang="en">
<p>
<b>BACKGROUND</b>
</p>
<p>Persistence with antimuscarinic therapy in overactive bladder (OAB) is poor, but may be different for mirabegron, a β</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>OBJECTIVE</b>
</p>
<p>To compare persistence and adherence with mirabegron versus tolterodine extended release (ER) and other antimuscarinics in routine clinical practice over a 12-mo period.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>DESIGN, SETTING, AND PARTICIPANTS</b>
</p>
<p>Retrospective, longitudinal, observational study of anonymised data from the UK Clinical Practice Research Datalink GOLD database. Eligibility: age ≥18 yr, ≥1 prescription for target OAB drug (between May 1, 2013 and June 29, 2014), and 12-mo continuous enrolment before and after the index prescription date.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>INTERVENTIONS</b>
</p>
<p>Mirabegron, darifenacin, fesoterodine, flavoxate, oxybutynin ER or immediate-release (IR), propiverine, solifenacin, tolterodine ER or IR, and trospium chloride.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS</b>
</p>
<p>The primary endpoint was persistence (time to discontinuation). Secondary endpoints included 12-mo persistence rates and adherence (assessed using medication possession ratio, MPR). Cox proportional-hazards regression models and logistic regression models adjusted for potential confounding factors were used to compare cohorts. Analyses were repeated after 1:1 matching.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS AND LIMITATIONS</b>
</p>
<p>The study population included 21996 eligible patients. In the unmatched analysis, the median time-to-discontinuation was significantly longer for mirabegron (169 d, interquartile range [IQR] 41-not reached) compared to tolterodine ER (56 d, IQR 28-254; adjusted hazard ratio [HR] 1.55, 95% confidence interval 1.41-1.71; p<0.0001) and other antimuscarinics (range 30-78 d; adjusted HR range 1.24-2.26, p<0.0001 for all comparisons). The 12-mo persistence rates and MPR were also significantly greater with mirabegron than with all the antimuscarinics. Limitations include the retrospective design, use of prescription records to estimate outcomes, and inability to capture reasons for discontinuation.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>Persistence and adherence were statistically significantly greater with mirabegron than with tolterodine ER and other antimuscarinics prescribed for OAB in the UK.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>PATIENT SUMMARY</b>
</p>
<p>This study assessed persistence and adherence (or compliance) with medications prescribed for OAB in a large UK population. We found that patients prescribed mirabegron remained on treatment for longer and showed greater adherence than those prescribed traditional antimuscarinics.</p>
</div>
</front>
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<Month>05</Month>
<Day>08</Day>
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<Month>09</Month>
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<Title>European urology</Title>
<ISOAbbreviation>Eur Urol</ISOAbbreviation>
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<ArticleTitle>Persistence and Adherence with Mirabegron versus Antimuscarinic Agents in Patients with Overactive Bladder: A Retrospective Observational Study in UK Clinical Practice.</ArticleTitle>
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<AbstractText Label="BACKGROUND">Persistence with antimuscarinic therapy in overactive bladder (OAB) is poor, but may be different for mirabegron, a β
<sub>3</sub>
-adrenoceptor agonist with a different adverse event profile.</AbstractText>
<AbstractText Label="OBJECTIVE">To compare persistence and adherence with mirabegron versus tolterodine extended release (ER) and other antimuscarinics in routine clinical practice over a 12-mo period.</AbstractText>
<AbstractText Label="DESIGN, SETTING, AND PARTICIPANTS">Retrospective, longitudinal, observational study of anonymised data from the UK Clinical Practice Research Datalink GOLD database. Eligibility: age ≥18 yr, ≥1 prescription for target OAB drug (between May 1, 2013 and June 29, 2014), and 12-mo continuous enrolment before and after the index prescription date.</AbstractText>
<AbstractText Label="INTERVENTIONS">Mirabegron, darifenacin, fesoterodine, flavoxate, oxybutynin ER or immediate-release (IR), propiverine, solifenacin, tolterodine ER or IR, and trospium chloride.</AbstractText>
<AbstractText Label="OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS">The primary endpoint was persistence (time to discontinuation). Secondary endpoints included 12-mo persistence rates and adherence (assessed using medication possession ratio, MPR). Cox proportional-hazards regression models and logistic regression models adjusted for potential confounding factors were used to compare cohorts. Analyses were repeated after 1:1 matching.</AbstractText>
<AbstractText Label="RESULTS AND LIMITATIONS">The study population included 21996 eligible patients. In the unmatched analysis, the median time-to-discontinuation was significantly longer for mirabegron (169 d, interquartile range [IQR] 41-not reached) compared to tolterodine ER (56 d, IQR 28-254; adjusted hazard ratio [HR] 1.55, 95% confidence interval 1.41-1.71; p<0.0001) and other antimuscarinics (range 30-78 d; adjusted HR range 1.24-2.26, p<0.0001 for all comparisons). The 12-mo persistence rates and MPR were also significantly greater with mirabegron than with all the antimuscarinics. Limitations include the retrospective design, use of prescription records to estimate outcomes, and inability to capture reasons for discontinuation.</AbstractText>
<AbstractText Label="CONCLUSIONS">Persistence and adherence were statistically significantly greater with mirabegron than with tolterodine ER and other antimuscarinics prescribed for OAB in the UK.</AbstractText>
<AbstractText Label="PATIENT SUMMARY">This study assessed persistence and adherence (or compliance) with medications prescribed for OAB in a large UK population. We found that patients prescribed mirabegron remained on treatment for longer and showed greater adherence than those prescribed traditional antimuscarinics.</AbstractText>
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<Keyword MajorTopicYN="Y">Mirabegron</Keyword>
<Keyword MajorTopicYN="Y">Observational</Keyword>
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<Year>2016</Year>
<Month>10</Month>
<Day>17</Day>
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<PubMedPubDate PubStatus="accepted">
<Year>2017</Year>
<Month>01</Month>
<Day>20</Day>
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<Month>2</Month>
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<Month>5</Month>
<Day>9</Day>
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<Day>16</Day>
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<Minute>0</Minute>
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<ArticleId IdType="pubmed">28196724</ArticleId>
<ArticleId IdType="pii">S0302-2838(17)30062-3</ArticleId>
<ArticleId IdType="doi">10.1016/j.eururo.2017.01.037</ArticleId>
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