title: Persistence and Adherence with Mirabegron versus Antimuscarinic Agents in Patients with Overactive Bladder: A Retrospective Observational Study in UK Clinical Practice.
abstract: Persistence with antimuscarinic therapy in overactive bladder (OAB) is poor, but may be different for mirabegron, a β3-adrenoceptor agonist with a different adverse event profile.
  
  
  
  To compare persistence and adherence with mirabegron versus tolterodine extended release (ER) and other antimuscarinics in routine clinical practice over a 12-mo period.
  
  
  
  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.
  
  
  
  Mirabegron, darifenacin, fesoterodine, flavoxate, oxybutynin ER or immediate-release (IR), propiverine, solifenacin, tolterodine ER or IR, and trospium chloride.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Persistence and adherence were statistically significantly greater with mirabegron than with tolterodine ER and other antimuscarinics prescribed for OAB in the UK.
  
  
  
  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.
authors.affiliation: Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK. Electronic address: c.r.chapple@sheffield.ac.uk.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Chapple
authors.affiliation: Astellas Pharma Europe Ltd., Astellas Medical Affairs, EMEA, HEOR, Chertsey, UK.
authors.forename: Jameel
authors.initials: J
authors.lastname: Nazir
authors.affiliation: Astellas Pharma Europe B.V., Astellas Medical Affairs, Global, HEOR, Leiden, Netherlands.
authors.forename: Zalmai
authors.initials: Z
authors.lastname: Hakimi
authors.affiliation: Astellas Pharma Europe Ltd., Astellas Medical Affairs, EMEA, HEOR, Chertsey, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Bowditch
authors.affiliation: Department of Health Professions, Manchester Metropolitan University, Manchester, UK.
authors.forename: Francis
authors.initials: F
authors.lastname: Fatoye
authors.affiliation: Creativ-Ceutical, Paris, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Guelfucci
authors.affiliation: Creativ-Ceutical SARL, Les Berges du lac, Tunisia.
authors.forename: Amine
authors.initials: A
authors.lastname: Khemiri
authors.affiliation: Astellas Pharma Europe Ltd., Astellas Medical Affairs, EMEA, HEOR, Chertsey, UK.
authors.forename: Emad
authors.initials: E
authors.lastname: Siddiqui
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wagg
mesh_terms: D000083:Acetanilides / Q000008:administration & dosage* / Q000009:adverse effects; D058667:Adrenergic beta-3 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013844:Thiazoles / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D064804:Urological Agents / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000083:Acetanilides; D058667:Adrenergic beta-3 Receptor Agonists; D018727:Muscarinic Antagonists; D013844:Thiazoles; D064804:Urological Agents; C520025:mirabegron
keywords: Adherence; Antimuscarinics; Mirabegron; Observational; Overactive bladder; Persistence