title: Persistence with solifenacin add-on therapy in men with benign prostate obstruction and residual symptoms of overactive bladder after tamsulosin monotherapy.
abstract: OBJECTIVE
  In spite of the reported efficacy and safety of antimuscarinics in men with OAB (overactive bladder) and BPO (benign prostatic obstruction), many patients do not persist with the treatment. We aimed to evaluate persistence and the reasons for the discontinuation of solifenacin add-on therapy in men with residual symptoms of OAB after tamsulosin monotherapy for BPO in a real clinical environment.
  
  
  METHODS
  Men aged ≥ 45 years with IPSS ≥ 12 and symptoms of OAB (OAB-V8 ≥ 8, micturition ≥ 8/24 h, urgency ≥ 2/24 h) were prescribed tamsulosin 0.2 mg. After 4 weeks, men who had residual symptoms of OAB (OAB-V8 ≥ 8, micturition ≥ 8/24 h, urgency ≥ 1/24 h) and reported that they were 'dissatisfied' or 'a little satisfied' with the therapy were enrolled and prescribed solifenacin 5 mg in combination with tamsulosin. After 52 weeks, persistence and the reasons for the discontinuation of solifenacin were evaluated. Factors related to persistence were analysed.
  
  
  RESULTS
  Of the 305 men who had been treated with tamsulosin, 176 were prescribed solifenacin. After 52 weeks, 44 (25%) remained on solifenacin therapy. Of the 132 who discontinued solifenacin, 85 were evaluated on the reason for discontinuation. The three most common reasons for discontinuation were adverse events (AEs) (35%), lack of efficacy (33%), and improvement in symptoms (16%). The aggravation of voiding symptoms was the most common AE leading to discontinuation. Retention was observed in 11 men. None of the demographical or clinical characteristics were significantly related to persistence.
  
  
  CONCLUSIONS
  Only 25% men with OAB and BPO remained on antimuscarinic add-on therapy after 1 year, mostly because of AEs and lack of efficacy. Realistic data should be added to what is already known about antimuscarinic treatment in men by including patients who were excluded or who dropped out of well-designed clinical trials.
authors.affiliation: Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
authors.forename: Y-S
authors.initials: YS
authors.lastname: Lee
authors.forename: K-S
authors.initials: KS
authors.lastname: Lee
authors.forename: J C
authors.initials: JC
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Hong
authors.forename: B H
authors.initials: BH
authors.lastname: Chung
authors.forename: C-S
authors.initials: CS
authors.lastname: Kim
authors.forename: J G
authors.initials: JG
authors.lastname: Lee
authors.forename: D K
authors.initials: DK
authors.lastname: Kim
authors.forename: C H
authors.initials: CH
authors.lastname: Park
authors.forename: J K
authors.initials: JK
authors.lastname: Park
mesh_terms: D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D011812:Quinuclidines / Q000008:administration & dosage; D000069464:Solifenacin Succinate / Q000494:pharmacology / Q000627:therapeutic use; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use; D000077409:Tamsulosin; D044005:Tetrahydroisoquinolines / Q000008:administration & dosage; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D018727:Muscarinic Antagonists; D011812:Quinuclidines; D013449:Sulfonamides; D044005:Tetrahydroisoquinolines; D000077409:Tamsulosin; D000069464:Solifenacin Succinate