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Overactive bladder medication: Persistence, drug switching, and reinitiation.

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Mirabegron shows longer treatment persistence for overactive bladder (OAB) than antimuscarinics. However, most patients discontinue OAB medications within a year, indicating a need for improved, individualized treatment strategies.

Keywords:
antimuscarinicsdiscontinuationoveractive bladderpersistenceß3-agonist

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Area of Science:

  • Urology
  • Pharmacology
  • Real-world evidence

Background:

  • Overactive bladder (OAB) affects millions globally, necessitating effective and persistent treatment strategies.
  • Current OAB pharmacotherapies, including antimuscarinics and ß3-agonists, exhibit variable patient adherence and persistence.
  • Understanding real-world treatment patterns is crucial for optimizing OAB management.

Purpose of the Study:

  • To evaluate real-world treatment profiles for antimuscarinics and ß3-agonists in overactive bladder (OAB) patients.
  • To analyze discontinuation rates, reasons for switching, reinitiation patterns, and follow-up care.
  • To compare treatment persistence between antimuscarinics and mirabegron.

Main Methods:

  • Retrospective chart review of 777 adult patients treated for OAB.
  • Data collection included demographics, OAB symptom severity, and medication details.
  • Treatment persistence assessed via median time to discontinuation and 12-month persistence rates.

Main Results:

  • Older age, male sex, and greater urgency severity correlated with higher OAB medication persistence.
  • Mirabegron demonstrated significantly longer persistence than antimuscarinics as first- or second-line therapy.
  • Urgency severity and mirabegron use were independent predictors of better treatment persistence (p<0.05).

Conclusions:

  • Introduction of mirabegron improved OAB medication persistence, yet discontinuation within a year remains common.
  • Treatment strategies for mild or medication-resistant OAB require enhancement.
  • Individualized treatment plans, potentially reducing pharmacotherapy reliance, are essential for better OAB patient outcomes.