Four Year Persistence and Drug Treatment Patterns in Overactive Bladder: Data From Canadian Datasets
CUA Online Library. Wagg A. 06/24/13; 31284; MP-04.12
Disclosure(s): I have received research suport, fees for consultancy and speaker fees from Astellas Pharma, Pfizer Corp, Watson Pharma and SCA
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Abstract
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Introduction and Objectives
Overactive bladder (OAB) is a prevalent and bothersome condition which increases in association with age (1). Many with OAB, need treatment with pharmacological agents to provide symptomatic relief. Despite the impact of OAB on morbidity and quality of life, persistence with antimuscarinic drugs is generally poor when compared to pharmaceutical treatment for other chronic medical conditions. In an analysis of longitudinal prescribing data from primary care the United Kingdom, at 12 months after an initial prescription, only 13.5 - 35% of patients remained on their treatment, with a mean persistence time for the 10 formulations studied, of 129 days (2). In the US, 35% of people failed to refill their prescription when drugs were free (3). The aim of this study was to investigate the long term persistence and treatment transitions of people prescribed an antimuscarinic drug for OAB in Canada.
Methods
Using data from IMS Brogan's Public and Private Drug Plans Databases (Private Drug Plans (PDP), Régie de l'Assurance Maladie du Québec (RAMQ), Ontario Public Drug Plans(OPDP)), patients receiving a first prescription for an OAB drug between April 1, 2007 and March 2008 were identified and followed for four years. A further three month period was assessed to ascertain continuation of treatment. Prescribing patterns, including initial and up to 6 treatment changes were identified. The average number of continuous days on any one treatment was calculated.
Results
Data were available for 31,833 patients for whom the median number of drugs prescribed was 2 (range 1 – 6). Initial prescription (oxybutynin / other) did not affect the number of antimuscarinics used throughout the 4 years. Table 1 shows treatment patterns by initial prescription and data set including the proportion of patients that changed treatment. The mean time (days, all datasets) for which patients were prescribed their initial therapy was: oxybutynin, 337; tolterodine, 327; tolterodine extended release, 410; trospium chloride, 356; flavoxate, 123; solifenacin, 455.5, darifenacin, 336 (1 database only).
Conclusion
Long term persistence with antimuscarinics is poor, regardless of prescribed medication. The mean length of prescription persistence on initial drug in Canada is higher than that reported from the United Kingdom (2) at one year.
References
1. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006 Dec;50(6):1306-14.
2. Wagg A, Compion G, Fahey A, Siddiqui E. Persistence with prescribed antimuscarinic therapy for overactive bladder: a UK experience. BU Int 2012 Dec;110(11):1767-74
3. Sears CL, Lewis C, Noel K, Albright TS, Fischer JR. Overactive bladder medication adherence when medication is free to patients. Journal of Urology. 2010 Mar;183(3):1077-81.
Overactive bladder (OAB) is a prevalent and bothersome condition which increases in association with age (1). Many with OAB, need treatment with pharmacological agents to provide symptomatic relief. Despite the impact of OAB on morbidity and quality of life, persistence with antimuscarinic drugs is generally poor when compared to pharmaceutical treatment for other chronic medical conditions. In an analysis of longitudinal prescribing data from primary care the United Kingdom, at 12 months after an initial prescription, only 13.5 - 35% of patients remained on their treatment, with a mean persistence time for the 10 formulations studied, of 129 days (2). In the US, 35% of people failed to refill their prescription when drugs were free (3). The aim of this study was to investigate the long term persistence and treatment transitions of people prescribed an antimuscarinic drug for OAB in Canada.
Methods
Using data from IMS Brogan's Public and Private Drug Plans Databases (Private Drug Plans (PDP), Régie de l'Assurance Maladie du Québec (RAMQ), Ontario Public Drug Plans(OPDP)), patients receiving a first prescription for an OAB drug between April 1, 2007 and March 2008 were identified and followed for four years. A further three month period was assessed to ascertain continuation of treatment. Prescribing patterns, including initial and up to 6 treatment changes were identified. The average number of continuous days on any one treatment was calculated.
Results
Data were available for 31,833 patients for whom the median number of drugs prescribed was 2 (range 1 – 6). Initial prescription (oxybutynin / other) did not affect the number of antimuscarinics used throughout the 4 years. Table 1 shows treatment patterns by initial prescription and data set including the proportion of patients that changed treatment. The mean time (days, all datasets) for which patients were prescribed their initial therapy was: oxybutynin, 337; tolterodine, 327; tolterodine extended release, 410; trospium chloride, 356; flavoxate, 123; solifenacin, 455.5, darifenacin, 336 (1 database only).
Conclusion
Long term persistence with antimuscarinics is poor, regardless of prescribed medication. The mean length of prescription persistence on initial drug in Canada is higher than that reported from the United Kingdom (2) at one year.
References
1. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006 Dec;50(6):1306-14.
2. Wagg A, Compion G, Fahey A, Siddiqui E. Persistence with prescribed antimuscarinic therapy for overactive bladder: a UK experience. BU Int 2012 Dec;110(11):1767-74
3. Sears CL, Lewis C, Noel K, Albright TS, Fischer JR. Overactive bladder medication adherence when medication is free to patients. Journal of Urology. 2010 Mar;183(3):1077-81.
Introduction and Objectives
Overactive bladder (OAB) is a prevalent and bothersome condition which increases in association with age (1). Many with OAB, need treatment with pharmacological agents to provide symptomatic relief. Despite the impact of OAB on morbidity and quality of life, persistence with antimuscarinic drugs is generally poor when compared to pharmaceutical treatment for other chronic medical conditions. In an analysis of longitudinal prescribing data from primary care the United Kingdom, at 12 months after an initial prescription, only 13.5 - 35% of patients remained on their treatment, with a mean persistence time for the 10 formulations studied, of 129 days (2). In the US, 35% of people failed to refill their prescription when drugs were free (3). The aim of this study was to investigate the long term persistence and treatment transitions of people prescribed an antimuscarinic drug for OAB in Canada.
Methods
Using data from IMS Brogan's Public and Private Drug Plans Databases (Private Drug Plans (PDP), Régie de l'Assurance Maladie du Québec (RAMQ), Ontario Public Drug Plans(OPDP)), patients receiving a first prescription for an OAB drug between April 1, 2007 and March 2008 were identified and followed for four years. A further three month period was assessed to ascertain continuation of treatment. Prescribing patterns, including initial and up to 6 treatment changes were identified. The average number of continuous days on any one treatment was calculated.
Results
Data were available for 31,833 patients for whom the median number of drugs prescribed was 2 (range 1 – 6). Initial prescription (oxybutynin / other) did not affect the number of antimuscarinics used throughout the 4 years. Table 1 shows treatment patterns by initial prescription and data set including the proportion of patients that changed treatment. The mean time (days, all datasets) for which patients were prescribed their initial therapy was: oxybutynin, 337; tolterodine, 327; tolterodine extended release, 410; trospium chloride, 356; flavoxate, 123; solifenacin, 455.5, darifenacin, 336 (1 database only).
Conclusion
Long term persistence with antimuscarinics is poor, regardless of prescribed medication. The mean length of prescription persistence on initial drug in Canada is higher than that reported from the United Kingdom (2) at one year.
References
1. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006 Dec;50(6):1306-14.
2. Wagg A, Compion G, Fahey A, Siddiqui E. Persistence with prescribed antimuscarinic therapy for overactive bladder: a UK experience. BU Int 2012 Dec;110(11):1767-74
3. Sears CL, Lewis C, Noel K, Albright TS, Fischer JR. Overactive bladder medication adherence when medication is free to patients. Journal of Urology. 2010 Mar;183(3):1077-81.
Overactive bladder (OAB) is a prevalent and bothersome condition which increases in association with age (1). Many with OAB, need treatment with pharmacological agents to provide symptomatic relief. Despite the impact of OAB on morbidity and quality of life, persistence with antimuscarinic drugs is generally poor when compared to pharmaceutical treatment for other chronic medical conditions. In an analysis of longitudinal prescribing data from primary care the United Kingdom, at 12 months after an initial prescription, only 13.5 - 35% of patients remained on their treatment, with a mean persistence time for the 10 formulations studied, of 129 days (2). In the US, 35% of people failed to refill their prescription when drugs were free (3). The aim of this study was to investigate the long term persistence and treatment transitions of people prescribed an antimuscarinic drug for OAB in Canada.
Methods
Using data from IMS Brogan's Public and Private Drug Plans Databases (Private Drug Plans (PDP), Régie de l'Assurance Maladie du Québec (RAMQ), Ontario Public Drug Plans(OPDP)), patients receiving a first prescription for an OAB drug between April 1, 2007 and March 2008 were identified and followed for four years. A further three month period was assessed to ascertain continuation of treatment. Prescribing patterns, including initial and up to 6 treatment changes were identified. The average number of continuous days on any one treatment was calculated.
Results
Data were available for 31,833 patients for whom the median number of drugs prescribed was 2 (range 1 – 6). Initial prescription (oxybutynin / other) did not affect the number of antimuscarinics used throughout the 4 years. Table 1 shows treatment patterns by initial prescription and data set including the proportion of patients that changed treatment. The mean time (days, all datasets) for which patients were prescribed their initial therapy was: oxybutynin, 337; tolterodine, 327; tolterodine extended release, 410; trospium chloride, 356; flavoxate, 123; solifenacin, 455.5, darifenacin, 336 (1 database only).
Conclusion
Long term persistence with antimuscarinics is poor, regardless of prescribed medication. The mean length of prescription persistence on initial drug in Canada is higher than that reported from the United Kingdom (2) at one year.
References
1. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006 Dec;50(6):1306-14.
2. Wagg A, Compion G, Fahey A, Siddiqui E. Persistence with prescribed antimuscarinic therapy for overactive bladder: a UK experience. BU Int 2012 Dec;110(11):1767-74
3. Sears CL, Lewis C, Noel K, Albright TS, Fischer JR. Overactive bladder medication adherence when medication is free to patients. Journal of Urology. 2010 Mar;183(3):1077-81.
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