Urological Science

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 29  |  Issue : 5  |  Page : 229--230

Editorial Comment: Comparative Persistence, Switch Rates, and Predictors for Discontinuation of Antimuscarinics for Overactive Bladder: A 10-year Nationwide Population-based Study in Taiwan


En Meng 
 Department of Surgery, Division of Urology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan

Correspondence Address:
En Meng
Department of Surgery, Division of Urology, National Defense Medical Center, Tri-Service General Hospital, Taipei
Taiwan




How to cite this article:
Meng E. Editorial Comment: Comparative Persistence, Switch Rates, and Predictors for Discontinuation of Antimuscarinics for Overactive Bladder: A 10-year Nationwide Population-based Study in Taiwan.Urol Sci 2018;29:229-230


How to cite this URL:
Meng E. Editorial Comment: Comparative Persistence, Switch Rates, and Predictors for Discontinuation of Antimuscarinics for Overactive Bladder: A 10-year Nationwide Population-based Study in Taiwan. Urol Sci [serial online] 2018 [cited 2021 Dec 2 ];29:229-230
Available from: https://www.e-urol-sci.com/text.asp?2018/29/5/229/240360


Full Text



Overactive bladder (OAB) is a storage symptom-based disorder that impacts nearly one-fifth of the general population, with a disproportionate prevalence in the elderly. No definite etiology is yet elucidated for OAB, although neurogenic, myogenic, inflammatory, and idiopathic causes have been proposed. Antimuscarinics were the main treatment for OAB before the launch of a β3 agonist. However, the adverse effects (AEs) of antimuscarinics, such as dry mouth and constipation, limit the persistence of using antimuscarinics. These AEs may contribute to nonadherence or discontinuation of the prescribed medication, which can lead to a return of OAB symptoms and a reduction in quality of life.[1] This retrospective, longitudinal, observational, cohort study analyzed the persistence and switch rates among different antimuscarinics prescribed for OAB using the Taiwan's National Health Insurance Research Database.

Up to 86% of patients discontinued antimuscarinics within 3 months in this study, and the persistence rate at 1 year with all target antimuscarinics (4.3%–7.6%) was lower than the data reported in the literature (8%–29%). The current study's findings might not represent the real-world situation in Taiwan due to the lack of age and gender analysis. The current guidelines recommend the use of any antimuscarinic or β3 agonist as afirst-line medical treatment for OAB, as efficacy among the two different classes is considered to be similar. The approach to treating OAB in healthy older adults is similar to younger adults; however, frail older adults may have increased challenges as comorbidities, functional or cognitive deficits, and concomitant medications play a greater role in their management.[2],[3]

An interesting finding in the study is that hyperlipidemia was the only risk factor for discontinuation of the antimuscarinics. Although no further analysis has been done to clarify this result, the authors proposed that this is possibly due to unknown multidrug interactions, a lack of efficacy, poor tolerability, or inconvenient dosing. Since hyperlipidemia may involve many chronic comorbidities of the middle-aged and more elderly population, multiple medicines, such as antihypertensives, oral antidiabetics, and statins, would have been prescribed to this group of patients. The middle-aged and elderly may want to decrease the number of medicines that they are taking and therefore cease taking antimuscarinics which are less critical than other medicines. More data and analysis are necessary to explain why hyperlipidemia would break the adherence of the antimuscarinics.

Mirabegron, an oral β3-adrenoceptor agonist that may cause detrusor relaxation during the storage phase, has been developed as a new agent for OAB in the past 10 years.[4] Randomized studies showed that mirabegron was equal in efficacy to the antimuscarinic agents while causing a lower incidence of dry mouth and constipation. Since the dry mouth is reported to be one of the reasons for discontinuing medication, previous studies suggested that adherence to treatment might be better with mirabegron than with antimuscarinic agents. The long-term persistence rates for both β3-adrenoceptor agonist and antimuscarinic agents in real-world clinical practice in Taiwan will be an interesting topic to explore in the future.

References

1Benner JS, Nichol MB, Rovner ES, Jumadilova Z, Alvir J, Hussein M, et al. Patient-reported reasons for discontinuing overactive bladder medication. BJU Int 2010;105:1276-82.
2Vouri SM, Kebodeaux CD, Stranges PM, Teshome BF. Adverse events and treatment discontinuations of antimuscarinics for the treatment of overactive bladder in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2017;69:77-96.
3Thüroff JW, Abrams P, Andersson KE, Artibani W, Chapple CR, Drake MJ, et al. EAU guidelines on urinary incontinence. Eur Urol 2011;59:387-400.
4Takasu T, Ukai M, Sato S, Matsui T, Nagase I, Maruyama T, et al. Effect of (R)-2-(2-aminothiazol-4-yl)-4'-{2-[(2-hydroxy-2-phenylethyl) amino] ethyl} acetanilide (YM178), a novel selective beta3-adrenoceptor agonist, on bladder function. J Pharmacol Exp Ther 2007;321:642-7.