Wagg Adrian S, Foley Steve, Peters John, Nazir Jameel, Kool-Houweling Leanne, Scrine Ludmila
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Royal Berkshire Hospital, Reading, UK.
Int J Clin Pract. 2017 Oct;71(10). doi: 10.1111/ijcp.12996. Epub 2017 Sep 14.
Persistence with antimuscarinic (AM) drugs prescribed for overactive bladder (OAB) is poor. This study aimed to compare persistence and adherence with the beta-3-adrenoceptor agonist mirabegron (MIR) vs AMs over 12 months.
This retrospective cohort analysis included patients aged ≥18 years who were prescribed MIR, or any AM. A 12-month look-back was used to assess inclusion eligibility. The primary end-point was persistence, defined as time to first discontinuation of index drug, during 1 year follow-up. The secondary end-point was adherence, estimated by medication possession ratio (MPR).
Inclusion criteria were met by 6189 patients. Those prescribed AMs were mostly treatment-naïve (range 72.9%-95.3%) vs 54.4% of MIR patients. There was greater persistence with MIR vs AM. The median number of days on therapy with MIR was 101, vs 27-56 for AMs. Patients receiving AMs were significantly more likely to discontinue than those receiving MIR (hazard ratio [HR] range 1.24-2.05, P < .01 for each AM vs MIR. In treatment-naïve patients, HRs ranged from 1.25 (solifenacin, P = .012) to 2.07 (oxybutynin IR, P < .001). In treatment-experienced patients, they ranged from 1.10 (fesoterodine, P = NS) to 2.12 (oxybutynin IR, P < .001). Adherence was greater with MIR (mean MPR 48.4%) than with AMs (range 27.6%-40.4%, P < .001). Treatment-experienced patients were significantly less likely to discontinue treatment (HR 0.87, P = .006).
MIR was associated with a significantly longer time to discontinuation, greater persistence and better adherence than AMs. However, there was a steep decline in persistence with all drugs after 1 month. This is unlikely to be wholly explained by anticholinergic adverse events, as it was also seen with MIR. The lower proportion of MIR patients who were treatment-naive reflects current prescribing guidelines whereby MIR is prescribed after an initial generic AM trial. The study was limited by the small number of MIR patients. Study identifier: ISN 178-MA-3059.
用于治疗膀胱过度活动症（OAB）的抗毒蕈碱（AM）药物的持续使用情况不佳。本研究旨在比较β3肾上腺素能受体激动剂米拉贝隆（MIR）与AM药物在12个月内的持续使用情况和依从性。
这项回顾性队列分析纳入了年龄≥18岁且开具了MIR或任何AM药物处方的患者。通过回顾12个月的用药情况来评估纳入资格。主要终点是持续使用时间，定义为在1年随访期间首次停用索引药物的时间。次要终点是依从性，通过药物持有率（MPR）进行评估。
6189例患者符合纳入标准。开具AM药物的患者大多是初治患者（比例范围为72.9% - 95.3%），而MIR患者中这一比例为54.4%。与AM药物相比，MIR的持续使用情况更好。MIR治疗的中位天数为101天，而AM药物为27 - 56天。接受AM药物治疗的患者比接受MIR治疗的患者更有可能停药（风险比[HR]范围为1.24 - 2.05，每种AM药物与MIR相比，P <.01。在初治患者中，HR范围为1.25（索利那新，P =.012）至2.07（奥昔布宁速释片，P <.001）。在有治疗经验的患者中，HR范围为1.10（非索罗定，P =无统计学意义）至2.12（奥昔布宁速释片，P <.001）。MIR的依从性更高（平均MPR为48.4%），高于AM药物（范围为27.6% - 40.4%，P <.001）。有治疗经验的患者停药的可能性显著更低（HR 0.87，P =.006）。
与AM药物相比，MIR的停药时间显著更长，持续使用情况更好，依从性也更佳。然而，所有药物在1个月后持续使用情况均急剧下降。这不太可能完全由抗胆碱能不良反应来解释，因为MIR也出现了这种情况。MIR初治患者比例较低反映了当前的处方指南，即MIR是在初始使用普通AM药物试验后才开具。本研究因MIR患者数量较少而受到限制。研究标识符：ISN 178 - MA - 3059。
