Sussman D, Yehoshua A, Kowalski J, Lee W, Kish J, Chaudhari S, Murray B
Division of Urology, Department of Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
Allergan Inc, Irvine, CA, USA.
Int J Clin Pract. 2017 Mar;71(3-4). doi: 10.1111/ijcp.12824.
Adherence and persistence rates of anticholinergic (ACH) therapies have been well described. To date, few studies describe these metrics for mirabegron in patients with overactive bladder.
This retrospective analysis of MarketScan database assessed adherence and persistence of patients receiving either mirabegron or ACH. Study eligibility required an index date (first prescription filled) between July 2012 and June 2013 with 12 months of continuous enrolment preindex date and 12 months of follow-up. Adherence was defined as a proportion of days covered of ≥ 80% among patients with at least 2 fills of index medication. Persistence measures included treatment failure described as either treatment discontinuation (medication supply gap ≥ 30 days) or switching to a different medication. A medication supply gap of ≥ 45 days was used as a sensitivity analysis.
The mean age of mirabegron users (n = 4037) was 67 years and 43% were ACH naïve while the mean age of ACH users was 62 years (n = 67,943). Over the 12-month follow-up period, 44% of patients treated with mirabegron and 31% of patients treated with ACH were adherent to their indexed medications. Treatment failure was 81% for mirabegron and 88% for ACH. Most mirabegron treatment failures were because of treatment discontinuation (67%) versus switching to ACH therapy (14%). The ACH discontinuation rate was 84% and treatment switching rate was 4%. The mean (standard deviation) time to treatment failure was 143 (130) days for mirabegron and 69 (69) days for ACH. Adherence and persistence patterns were similar in the sensitivity analysis using a ≥ 45-day supply gap threshold.
This real-world study demonstrated low adherence and persistence to mirabegron similar to ACH therapies.
抗胆碱能（ACH）疗法的依从性和持续性已得到充分描述。迄今为止，很少有研究描述米拉贝隆在膀胱过度活动症患者中的这些指标。
对MarketScan数据库进行的这项回顾性分析评估了接受米拉贝隆或ACH治疗的患者的依从性和持续性。研究入选标准要求索引日期（首次配药）在2012年7月至2013年6月之间，索引日期前连续入组12个月，随访12个月。依从性定义为至少有2次索引药物配药的患者中覆盖天数比例≥80%。持续性指标包括治疗失败，定义为治疗中断（药物供应缺口≥30天）或改用其他药物。使用≥45天的药物供应缺口进行敏感性分析。
米拉贝隆使用者（n = 4037）的平均年龄为67岁，43%未使用过ACH，而ACH使用者的平均年龄为62岁（n = 67943）。在12个月的随访期内，接受米拉贝隆治疗的患者中有44%、接受ACH治疗的患者中有31%对其索引药物具有依从性。米拉贝隆的治疗失败率为81%，ACH为88%。米拉贝隆的大多数治疗失败是由于治疗中断（67%），而改用ACH治疗的比例为14%。ACH的中断率为84%，治疗转换率为4%。米拉贝隆治疗失败的平均（标准差）时间为143（130）天，ACH为69（69）天。在使用≥45天供应缺口阈值的敏感性分析中，依从性和持续性模式相似。
这项真实世界研究表明，米拉贝隆的依从性和持续性较低，与ACH疗法相似。
