Long-term adherence to antimuscarinic therapy in everyday practice: a systematic review
Veenboer PW, Ruud Bosch JL. J Urol. 2013 Oct 15. pii: S0022-5347(13)05654-1. doi: 10.1016/j.juro.2013.10.046. [Epub ahead of print]

Source

Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: P.W.Veenboer-2@umcutrecht.nl.

Abstract

PURPOSE: Antimuscarinic drug treatment is known to have side effects and, consequently, poor adherence to therapeutic regimes. This systematic review aims to study the long-term (>6 months) adherence to antimuscarinic drugs in daily clinical practice and to identify factors contributing to poor adherence and persistence.

MATERIALS AND METHODS: This systematic review was done according to PRISMA guidelines. A literature search was performed using PubMed and Embase, using synonyms for incontinence, overactive bladder and antimuscarinics, combined with synonyms for medication adherence. We chose to include only pharmaceutical database studies (using prescription/insurance claim data) and patients' self-report studies, using established pharmaco-epidemiological parameters such as persistence rate and medication possession rate (MPR).

RESULTS: A total of 1245 titles were screened, of which 102 abstracts were assessed. Fourteen studies were finally included, comprising 190,279 unique patients (mean age 69.5 years). Regardless of which specific antimuscarinic drug is studied, persistence rates are usually poor. Considering all drugs together, median persistence rates were 12.0%-39.4% (with an outlier of 75.5%) at 12 months, 8.0%-15.0% at 18 months and 6.0%-12.0% at 24 months. At 36 months, persistence rates ranged from 0.0% (darifenacin) to 16.0% (trospium). Mean reported MPRs were also low, with a mean of 0.37 at 12 months. Risk factors for discontinuation were identified, the most important being younger age groups, use of oxybutynin, and the use of IR formulations.

CONCLUSIONS: Improvement of adherence and persistence with antimuscarinic medication should be an important goal in the development of new drugs for overactive bladder and urinary incontinence.