EURURO Vol. 72 No. 3

389 476

Platinum Priority – Incontinence
Editorial by Alan J. Wein on pp. 400–401 of this issue
Persistence and Adherence with Mirabegron versus
Antimuscarinic Agents in Patients with Overactive Bladder:
A Retrospective Observational Study in UK Clinical Practice
Christopher R. Chapple Jameel Nazir Zalmai Hakimi Sally Bowditch Francis Fatoye
Florent Guelfucci Amine Khemiri Emad Siddiqui Adrian Wagg
a Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK; bAstellas Pharma Europe Ltd., Astellas Medical Affairs,
EMEA, HEOR, Chertsey, UK; c Astellas Pharma Europe B.V., Astellas Medical Affairs, Global, HEOR, Leiden, Netherlands; d Department of Health Professions,
Manchester Metropolitan University, Manchester, UK; e Creativ-Ceutical, Paris, France; f Creativ-Ceutical SARL, Les Berges du lac, Tunisia; g Department of
Medicine, University of Alberta, Edmonton, Alberta, Canada
ava ilable at
journal homepage:
Article info
Article history:
Accepted January 20, 2017
Associate Editor:
Christian Gratzke
Keywords:
Adherence
Antimuscarinics
Mirabegron
Observational
Overactive bladder
Persistence
Abstract
Background: Persistence with antimuscarinic therapy in overactive bladder (OAB) is poor, but
may be different for mirabegron, a b3-adrenoceptor agonist with a different adverse event
profile.
Objective: To compare persistence and adherence with mirabegron versus tolterodine ex-
tended release (ER) and other antimuscarinics in routine clinical practice over a 12-mo period.
Design, setting, and participants: Retrospective, longitudinal, observational study of anon-
ymised 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.
Interventions: Mirabegron, darifenacin, fesoterodine, flavoxate, oxybutynin ER or immediate-
release (IR), propiverine, solifenacin, tolterodine ER or IR, and trospium chloride.
Outcome measurements and statistical analysis: 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.
Results and limitations: The study population included 21 996 eligible patients. In the un-
matched 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.
Conclusions: Persistence and adherence were statistically significantly greater with mirabe-
gron than with tolterodine ER and other antimuscarinics prescribed for OAB in the UK.
Patient summary: 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.
# 2017 European Association of Urology. Published by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license ).
* Corresponding author. Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield,
S10 2JF, UK. Tel. +44 114 2713048; Fax: +44 114 2797841.
E-mail address: (C.R. Chapple).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. This is an open access article under the CC
BY-NC-ND license ).