Prescriptions for OAB Often Fail to Stick

Neil Osterweil

July 05, 2022

AMSTERDAM — Women with overactive bladders (OABs) appear to discontinue therapy more frequently in the real world than has been previously reported, results of a large medication database study found.

Among more than 46,000 women who made nearly 800,000 claims for medications to treat OAB in an Israeli database, the overall rate at which the drugs continued to be taken was 49% over 30 days and 34% over 90 days. But only 9% of patients still had a prescription in their possession 1 year after beginning to take a medication, according to Karin Lifshitz, MD, a urologist at Tel Aviv Medical Center.

"It does not matter whether you started with an anticholinergic or a beta-3 agonist; the next likely step in the treatment sequence is just going to be treatment cessation," Lifshitz said in an oral abstract session at the European Association of Urology (EAU) 2022 Annual Meeting. The abstract was selected as one of the best of the meeting.

Lifshitz and her colleagues defined "treatment persistence" as days in which the patient was in possession of a medication. "Nonpersistence" was defined as not refilling a prescription for at least 90 days.

Effective for Bladder Control

Medical therapies for OAB have been shown to be effective in controlled clinical trials, but 1-year treatment persistence for anticholinergic agents has been reported to be as low as 25%, and persistence rates with beta-3 agonists have been reported to be as low as 40%, Lifshitz said.

To see whether real-world data on treatment continuation and treatment sequence differed from reports, Lifshitz and her colleagues used advanced data-mining techniques to evaluate data from Israel's largest healthcare provider on all OAB medications purchased by women from 2010 through 2020.

They identified a total of 46,079 women who made 791,687 unique purchases of OAB medications.

The drugs included in the analysis were fesoterodine (Toviaz) in 4- and 8-mg doses, mirabregon (Mybetriq) in 25- and 50-mg doses, oxybutyni (Ditropan XL) 5 mg, solifenacin (Vesicare) in 5- and 10-mg doses, tolterodine (Detrol) in 2- and 4-mg doses, and trospium (Sanctura) in 15-, 20-, and 30-mg doses.

The 1-year persistence rate was highest for mirabegron (10%) and oxybutynin (11%) compared with all other medications (4%; P < .005). Older patients were more likely to continuing filling their prescriptions than younger patients.

The researchers also assessed the periods before and after the introduction of mirabegron, which has a favorable safety and tolerability trial compared with other therapies. The introduction of the drug did not have a significant effect on what patients were prescribed after the first prescription.

Study Limitations

"The persistence rate exposed by the authors is quite low compared to what has been observed in previous studies on this topic," said Jean-Nicola Cornu, MD, PhD, from the University of Rouen, France, who was an invited discussant.

He noted that in a 2017 study of OAB, persistence with mirabegron was significantly better than with tolterodine or traditional antimuscarinic agents, as compared to the low rate seen by Lifshitz's group.

Part of the difference may be explained by the inability of database studies to include demographic factors that might account for treatment interruptions. The study also did not evaluate potential contributors to treatment interruption or factors such as lack of efficacy, adverse events, disease evolution, alternative therapeutic options, or the cost of therapy, Cornu said.

The study by was internally funded. Lifshitz has disclosed no relevant financial relationships. Cornu has financial relationships with multiple pharmaceutical companies.

European Association of Urology (EAU) 2022 Annual Meeting: Abstract A0442. Presented July 3, 2022.

Neil Osterweil, an award-winning medical journalist, is a long-standing and frequent contributor to Medscape.

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