1
|
Dmochowski RR, Newman DK, Rovner ES, Zillioux J, Malik RD, Ackerman AL. Patient and Clinician Challenges with Anticholinergic Step Therapy in the Treatment of Overactive Bladder: A Narrative Review. Adv Ther 2023; 40:4741-4757. [PMID: 37725308 PMCID: PMC10567877 DOI: 10.1007/s12325-023-02625-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/21/2023] [Indexed: 09/21/2023]
Abstract
Anticholinergics have been used in the treatment of overactive bladder (OAB), but their use is limited by poor tolerability and anticholinergic-related side effects. Increasingly, providers are discontinuing anticholinergic prescribing because of growing evidence of the association of anticholinergic use with increased risk of cognitive decline and other adverse effects. Newer medications for OAB, the β3-adrenergic receptor agonists mirabegron and vibegron, do not have anticholinergic properties and are typically well tolerated; however, many insurance plans have limited patient access to these newer OAB medications by requiring step therapy, meaning less expensive anticholinergic medications must be trialed and/or failed before a β3-agonist will be covered and dispensed. Thus, many patients are unable to easily access these medications. Step therapy and other drug utilization strategies (e.g., prior authorization) are often used to manage the growing costs of pharmaceuticals, but these policies do not always follow treatment guidelines and may harm patients as a result of treatment delays, discontinuations, or related increases in adverse events. Medical professionals have called for reform of drug utilization strategies through partnerships that include clinicians and policymakers. This narrative review discusses prescribing patterns for OAB treatment and the effect of switching between drugs, as well as the costs of step therapy and prior authorization on patients and prescribers.
Collapse
Affiliation(s)
- Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Jacqueline Zillioux
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rena D Malik
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - A Lenore Ackerman
- Departments of Urology and Obstetrics and Gynecology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Box 951738, Los Angeles, CA, 90095-1738, USA.
| |
Collapse
|
2
|
Kuo HC. How to choose appropriate medication for overactive bladder: Findings from the largest integrated clinical trial database analysis of mirabegron studies. Tzu Chi Med J 2022; 34:23-28. [PMID: 35233352 PMCID: PMC8830553 DOI: 10.4103/tcmj.tcmj_167_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 11/04/2022] Open
Abstract
Medical treatment of overactive bladder (OAB) includes antimuscarinic agents, beta-3 adrenoceptor agonist (mirabegron), or combination with both drugs. Recently, a meta-analysis reported the integrated clinical trial data from 10 phase 2–4, double-blind, 12-week mirabegron monotherapy studies. The results confirmed that mirabegron is as effective as the previously used antimuscarinic agent to treat OAB. The treatment-emergent adverse events were similar across subgroups. This article comments on this largest integrated clinical trial data analysis, and reviews the recently published literature and tries to reveal how to choose the appropriate medication for OAB. For OAB patients, starting from antimuscarinic agent is feasible. However, if the patients have risk of cognitive dysfunction, a history of constipation, dry mouth, and urinary retention, starting with mirabegron 50 mg might be more safe and appropriate. In the elderly patients with low detrusor contractility, with central nervous system lesion, and men with benign prostatic hyperplasia, starting from 25 mg mirabegron is recommended. If the treatment result is not satisfactory to the 25 mg mirabegron, increase dose to 50 mg mirabegron is appropriate. In patients who have failed from the first OAB medication either with antimuscarinics or mirabegron 50 mg, the exchange of the OAB medication to each other should be tried first. If the treatment result is still not satisfactory, a combination of antimuscarinics and mirabegron is recommended.
Collapse
|
3
|
Wani MM, Sheikh MI, Bhat T, Bhat Z, Bhat A. Comparison of antimuscarinic drugs to beta adrenergic agonists in overactive bladder: A literary review. Curr Urol 2021; 15:153-160. [PMID: 34552455 PMCID: PMC8451319 DOI: 10.1097/cu9.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/20/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to carry an extended literature review to compare antimuscarnics with beta adrenergic agonists (mirabegron) in treatment of overactive bladder. MATERIALS AND METHODS A literature review was carried out, using key words in different databases including MEDLINE, PUBMED, and EMBASE. All relevant published articles during last 5 years with full texts available were included in this review for critical analysis and evaluation. In total, there were 20 studies including 7 systemic reviews, 6 retrospective cohort, 3 prospective cohort, 2 randomized controlled trials, and 2 cross sectional studies. RESULTS After critical evaluation the results were considered under parameters of efficacy, adverse effects, adherence and persistence, tolerability, cost-effectiveness. In 9 studies efficacy was evaluated, 5 studies dealt with adverse effects, same number evaluated adherence and persistence. Cost effectiveness was compared in 3 and same number of studies also compared tolerability. CONCLUSIONS To conclude, we found mirabegron is as efficacious as any other antimuscarnics, has better tolerability (including elderly), has better adverse effect profile, is cost effective, has better persistence and adherence rates at 12 months.
Collapse
Affiliation(s)
- Mudassir M. Wani
- Department of Urology, Glangwili General Hospital, Carmarthen, Wales, UK
| | | | - Tahir Bhat
- Department of Urology, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Zubair Bhat
- Department of Urology, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Arshad Bhat
- Department of Urology, Hereford County Hospital, Hereford, Herefordshire, UK
| |
Collapse
|
4
|
Wang HJ, Kuo HC. Effects of different urodynamic characteristics on therapeutic outcomes of overactive bladder medication in a real-life clinical practice. Tzu Chi Med J 2021; 34:441-447. [PMID: 36578645 PMCID: PMC9791855 DOI: 10.4103/tcmj.tcmj_264_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/14/2020] [Accepted: 12/01/2020] [Indexed: 12/31/2022] Open
Abstract
Objective This study retrospectively investigated the influence of urodynamic parameters and patient characteristics on success rates among patients with overactive bladder (OAB) and urodynamic detrusor overactivity (DO). Materials and Methods Consecutive patients with OAB and urodynamic DO initially received solifenacin, mirabegron, or combination of both for 1-3 months. If failed, patients were switched to another OAB medication subtype or provided additional OAB medication for a total of 6 months. A successful treatment was defined as an improvement in urgency severity and a global response assessment of ≥1. Success rates after initial or modulated OAB medication were analyzed based on patient and urodynamic characteristics. Results A total of 453 patients were enrolled, among whom 144, 255, and 54 received solifenacin, mirabegron, and combined medications, respectively. Among the patients, 259 (57.2%) had OAB dry and 194 (42.8%) had OAB wet. Patients receiving mirabegron alone had a significantly higher initial medication success rate compared to that of others. Patients with a phasic DO (50.7%), bladder outlet obstruction (BOO, 52.5%), and no central nervous system (CNS) lesions (47.5%) exhibited higher success rates than those with a terminal DO (42.0%), no BOO (42.7%), and CNS lesions (31.6%), respectively. After switching or modulating the initial OAB medication following treatment failure, 115 (62.2%) of 185 patients still showed improvement in OAB symptoms, with an overall success rate of 70.2% after 6 months of treatment. Conclusion Initial solifenacin or mirabegron treatment had a success rate of around 50%. In general, patients with a phasic DO, urodynamic BOO, and no CNS lesions have higher success rates than those with a terminal DO, no BOO, and CNS lesions, respectively. Success rates can further be improved by switching or modulating OAB medication.
Collapse
Affiliation(s)
- Hsiu-Jen Wang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan,Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan,School of Medicine, Tzu Chi University, Hualien, Taiwan,Address for correspondence: Dr. Hann-Chorng Kuo, Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung-Yang Road, Hualien, Taiwan. E-mail:
| |
Collapse
|
5
|
Wang C, Jiang Y, Kuo H. Higher urge severity score predicts resumption of overactive bladder (OAB) medication following discontinuation of mirabegron treatment in patients with OAB. Low Urin Tract Symptoms 2019; 11:O180-O185. [DOI: 10.1111/luts.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/09/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Chung‐Cheng Wang
- Department of Urology, En Chu Kong Hospital, College of MedicineNational Taiwan University New Taipei Taiwan
- Department of Biomedical EngineeringChung Yuan Christian University Taoyuan Taiwan
| | - Yung‐Hong Jiang
- Department of UrologyBuddhist Tzu Chi General Hospital and Tzu Chi University Hualien Taiwan
| | - Hann‐Chorng Kuo
- Department of UrologyBuddhist Tzu Chi General Hospital and Tzu Chi University Hualien Taiwan
| |
Collapse
|
6
|
Mirabegron escalation to 50 mg further improves daily urgency and urgency urinary incontinence in Asian patients with overactive bladder. J Formos Med Assoc 2019; 118:700-706. [DOI: 10.1016/j.jfma.2018.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/04/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022] Open
|
7
|
Factors associated with antimuscarinic drug persistence and increasing drug persistence after switching to mirabegron for overactive bladder patients. J Formos Med Assoc 2019; 118:279-284. [DOI: 10.1016/j.jfma.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/31/2017] [Accepted: 05/07/2018] [Indexed: 11/19/2022] Open
|
8
|
Yeowell G, Smith P, Nazir J, Hakimi Z, Siddiqui E, Fatoye F. Real-world persistence and adherence to oral antimuscarinics and mirabegron in patients with overactive bladder (OAB): a systematic literature review. BMJ Open 2018; 8:e021889. [PMID: 30467131 PMCID: PMC6252764 DOI: 10.1136/bmjopen-2018-021889] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate persistence and adherence of oral pharmacotherapy used in the treatment of overactive bladder (OAB) in a real-world setting. MATERIALS AND METHODS Systematic literature searches of six electronic publication databases were performed to identify observational studies of patients with OAB treated with antimuscarinics and/or mirabegron. Studies obtaining persistence and adherence data from sources other than electronic prescription claims were excluded. Reference lists of identified studies and relevant systematic reviews were assessed to identify additional relevant studies. RESULTS The search identified 3897 studies, of which 30 were included. Overall, persistence ranged from 5% to 47%. In studies reporting data for antimuscarinics and mirabegron (n=3), 1-year persistence was 12%-25% and 32%-38%, respectively. Median time to discontinuation was <5 months for antimuscarinics (except one study (6.5 months)) and 5.6-7.4 months for mirabegron. The proportion of patients adherent at 1 year varied between 15% and 44%. In studies reporting adherence for antimuscarinics and mirabegron, adherence was higher with mirabegron (mean medication possession ratio (MPR): 0.59 vs 0.41-0.53; mean proportion of days covered: 0.66 vs 0.55; and median MPR: 0.65 vs 0.19-0.49). Reported determinants of persistence and adherence included female (sex), older age group, use of extended-release formulation and treatment experience. CONCLUSION Most patients with OAB discontinued oral OAB pharmacotherapy and were non-adherent 1 year after treatment initiation. In general, mirabegron was associated with greater persistence and adherence compared with antimuscarinics. Combined with existing clinical trial evidence, this real-world review merits consideration of mirabegron for first-line pharmacological treatment among patients with OAB. PROSPERO REGISTRATION NUMBER CRD42017059894.
Collapse
Affiliation(s)
| | - Philip Smith
- Manchester Metropolitan University, Manchester, UK
| | | | | | | | | |
Collapse
|
9
|
Kuo HC. Individualizing medical treatment of overactive bladder. Tzu Chi Med J 2018; 30:195-199. [PMID: 30305780 PMCID: PMC6172903 DOI: 10.4103/tcmj.tcmj_83_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 04/30/2018] [Accepted: 05/13/2018] [Indexed: 12/27/2022] Open
Abstract
Overactive bladder (OAB) syndrome is highly prevalent in both men and women and might have negative impact on quality of life. Clinical trials of OAB usually highly select participants that may not reflect the real-world practice of OAB patients. The spectrum of OAB includes patients with idiopathic, neuropathic, with bladder outlet obstruction, and patients in elderly and medical comorbidities. Patients might have poor response to OAB medication or have adverse events after treatment. Therefore, treatment of OAB should be individualized to obtain therapeutic efficacy and avoid unacceptable adverse events. This article reviews the recently published literature and provides a guide for physicians to choose the appropriate treatment for different OAB patients.
Collapse
Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
10
|
Chen TF, Huang HC, Lin YH, Liao CH, Chiang BJ. Preliminary experience and possible predictors of successful mirabegron treatment for overactive bladder. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
11
|
Liao CH, Kuo HC. Current consensus and controversy on the treatment of male lower urinary tract symptoms/benign prostatic hyperplasia. Tzu Chi Med J 2017; 29:1-5. [PMID: 28757756 PMCID: PMC5509190 DOI: 10.4103/tcmj.tcmj_2_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are highly prevalent in men and increase with age. Because LUTS are common among elderly men, they are usually considered synonymous with benign prostatic hyperplasia (BPH). Drugs should be the first-line treatment for BPH and surgical intervention should be performed only when there are complications or LUTS refractory to medical treatment. In addition to medical treatment, several minimally invasive therapies, such as thermal therapy, prostatic lift, laser evaporation, or laser enucleation techniques have been developed. Recent investigations have also revealed that bladder dysfunction such as detrusor overactivity and detrusor underactivity may also contribute to male LUTS. In the treatment of LUTS suggestive of BPH (LUTS/BPH), the following questions should be considered: Is there an obstruction? Are we treating BPH or LUTS? Can management targeting BPH reduce LUTS? Should patients with LUTS be treated before bladder outlet obstruction is confirmed? What is the role of transurethral resection of the prostate (TURP) nowadays? Will new techniques provide better outcomes than TURP? This article discusses the current consensus and controversies in the treatment of LUTS/BPH.
Collapse
Affiliation(s)
- Chun-Hou Liao
- Department of Urology, Cardinal Tien Hospital and Fu-Jen Catholic University, New Taipei, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| |
Collapse
|