CYP2D6 Substrate Dispensing Among Patients Dispensed Mirabegron: An Administrative Claims Analysis
Mary E Ritchey1, Jingjun Wang2, Jessica C Young1
1CERobs Consulting, LLC, Chapel Hill, NC, USA.
Drugs - Real World Outcomes
|December 1, 2022
Summary
Overactive bladder (OAB) drug mirabegron is often prescribed with other medications that can cause adverse effects. Many patients taking mirabegron also receive cytochrome P450 (CYP) 2D6 substrates, increasing potential drug interactions.
Area of Science:
- Pharmacology
- Geriatrics
- Drug Interactions
Background:
- Overactive bladder (OAB) is a common condition with significant impact on quality of life.
- Pharmacologic treatments for OAB include anticholinergics and β3-adrenergic agonists.
- β3-adrenergic agonists offer potential efficacy with a reduced side effect profile compared to anticholinergics, but mirabegron inhibits CYP2D6, raising concerns for drug interactions.
Purpose of the Study:
- To quantify the frequency of co-dispensing cytochrome P450 (CYP) 2D6 substrates in patients receiving mirabegron.
- To analyze these co-dispensing patterns in both adult and older adult (≥ 65 years) populations.
Main Methods:
- Retrospective analysis of a US administrative claims database (IQVIA PharMetrics® Plus) from November 2012 to September 2019.
- Identified dispensing claims for mirabegron and CYP2D6 substrates in adults (≥ 18 years) and older adults (≥ 65 years).
- Categorized CYP2D6 substrates based on potential risks (e.g., QT prolongation, anticholinergic properties, narrow therapeutic index, contraindications with CYP2D6 inhibitors, psychiatric use).
Main Results:
- Nearly 70% of adult mirabegron users received at least one CYP2D6 substrate, with similar rates in older adults (72.1%).
- Commonly co-dispensed substrates included those with anticholinergic properties (60.6%) and risk of QT prolongation (53.6%).
- Patients receiving concurrent CYP2D6 substrates were more likely to be older, have more comorbidities, and use more medications.
Conclusions:
- Co-dispensing of CYP2D6 substrates, particularly those with anticholinergic properties or QT prolongation risk, is frequent in patients treated with mirabegron.
- These findings underscore the need for increased clinician awareness regarding potential drug interactions when prescribing mirabegron.
- Improved management strategies are needed to mitigate risks associated with CYP2D6 inhibition by mirabegron.
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