title: Adherence to Oral Therapy for Urgency Urinary Incontinence: Results from the Anticholinergic Versus Botox Comparison (ABC) Trial.
abstract: OBJECTIVE
  Medication adherence with urgency urinary incontinence (UUI) treatment is challenging and the best assessment methodology is uncertain. We sought to describe adherence with anticholinergic (AC) versus placebo (P) by comparing pill counts and MEMSCAP event data and to identify factors associated with adherence.
  
  
  METHODS
  The randomized controlled AC versus Botox Comparison trial of women with moderate to severe idiopathic UUI included 126 participants initiating AC plus P bladder injection and 121 receiving P pills plus Botox injection. Adherence data on 243 participants (124 AC and 119 P) were calculated by pill count and MEMSCAP data for each 2-month interval during the 6-month study that allowed for dose escalation/drug change. Overall composite adherence estimates were calculated using the average of both methods and weighted by the duration of each 2-month interval.
  
  
  RESULTS
  Treatment groups had no significant differences in dosing duration (P = 0.76) or mean adherence (AC, 83.3% [16.8] vs. P, 84.8% [13.8]). Only 53% of women met the dichotomous outcome of more than 80% adherence during all intervals. Correlation between adherence by pill counts versus MEMSCAP decreased over time with pill counts demonstrating higher adherence than MEMSCAP (r = 0.53, 0.50, and 0.36 for each 2-month interval). Lower adherence was associated with higher baseline incontinence severity and better UUI quality of life for the AC group and with current smoking status in both groups.
  
  
  CONCLUSIONS
  Adherence using pill counts and MEMSCAP was reasonably correlated and similar in both the AC and P groups. In the AC group, higher baseline incontinence severity and better UUI Quality of Life were associated with decreased adherence. Smokers were less adherent.
authors.affiliation: From the *Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC; †Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL; ‡Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH; §Department of Urology, University of Alabama at Birmingham, Birmingham, AL; ∥Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT; ¶Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; **Department of Biostatistics, University of Michigan, Ann Arbor; ††Department of Urology, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI; ‡‡Department of Obstetrics and Gynecology, Kaiser Permanente Downey, Downey, CA; §§Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; ∥∥Gynecologic Health and Disease Branch, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD and ¶¶RTI International, Research Triangle Park, NC.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Visco
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
authors.forename: J Eric
authors.initials: JE
authors.lastname: Jelovsek
authors.forename: Tracey S
authors.initials: TS
authors.lastname: Wilson
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.forename: Halina M
authors.initials: HM
authors.lastname: Zyczynski
authors.forename: Cathie
authors.initials: C
authors.lastname: Spino
authors.forename: Larry
authors.initials: L
authors.lastname: Sirls
authors.forename: John N
authors.initials: JN
authors.lastname: Nguyen
authors.forename: David D
authors.initials: DD
authors.lastname: Rahn
authors.forename: Susie F
authors.initials: SF
authors.lastname: Meikle
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Nolen
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage*; D000283:Administration, Intravesical; D000284:Administration, Oral; D001561:Benzilates / Q000008:administration & dosage*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage*; D009662:Nortropanes / Q000008:administration & dosage*; D011446:Prospective Studies; D000069464:Solifenacin Succinate / Q000008:administration & dosage*; D016896:Treatment Outcome; D053202:Urinary Incontinence, Urge / Q000188:drug therapy*; D064804:Urological Agents / Q000008:administration & dosage
chemical_list: D065087:Acetylcholine Release Inhibitors; D001561:Benzilates; D018727:Muscarinic Antagonists; D009662:Nortropanes; D064804:Urological Agents; C003330:trospium chloride; D019274:Botulinum Toxins, Type A; D000069464:Solifenacin Succinate