A retrospective study of treatment persistence and adherence to alpha-blocker plus antimuscarinic combination therapies, in men with LUTS/BPH in the Netherlands

A retrospective study of treatment persistence and adherence to alpha-blocker plus antimuscarinic combination therapies, in men with LUTS/BPH in the Netherlands

2017 BMC Urol

Drake, M. J. | Bowditch, S. | Arbe, E. | Hakimi, Z. | Guelfucci, F. | Amri, I. | Nazir, J. | Volume: 17, Issue: 1, Pages: 36, Adrenergic alpha-Antagonists/*administration & dosage, Aged, Cohort Studies, Drug Therapy, Combination, Humans, Lower Urinary Tract Symptoms/*drug therapy/etiology, Male, Medication Adherence/*statistics & numerical data, Middle Aged, Muscarinic Antagonists/*administration & dosage, Netherlands, Prostatic Hyperplasia/complications/*drug therapy, Retrospective Studies, Solifenacin Succinate/*administration & dosage, Tolterodine Tartrate/*administration & dosage, Antimuscarinic, Fixed-dose combination, Luts/bph, Treatment persistence, alpha-blocker,

BACKGROUND: To assess treatment persistence and adherence in men >/=45 years of age with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), using prescription records from the Netherlands IMS Lifelink LRx database. METHODS: In this retrospective, observational cohort study, we identified men who received combination therapy with an alpha-blocker plus an antimuscarinic (e.g. solifenacin or tolterodine) between 1 November 2013 and 31 October 2014. Treatment could be received as a fixed-dose combination (FDC) tablet or as two drugs administered together (concomitant therapy), if both combination drugs were prescribed within 30 days. The primary objective was to assess treatment persistence, defined as the time from initiation of combination therapy until first discontinuation of the FDC or at least one of the drugs given concomitantly (i.e. >/=30 days without prescription renewal). Subgroup and sensitivity analyses were conducted to assess persistence by antimuscarinic agent, and with different gap lengths used to define discontinuation (45, 60 and 90 days), respectively. RESULTS: A total of 1891 men received an alpha-blocker plus an antimuscarinic (FDC, N = 665; concomitant therapy, N = 1226). Median time to discontinuation was significantly longer with FDC versus concomitant therapy (414 vs. 112 days; adjusted hazard ratio [HR] 2.04, 95% confidence interval 1.77, 2.35; p < 0.0001). Persistence at 12 months (51.3% vs. 29.9%) was also significantly greater with FDC compared with concomitant therapy. Assessment of antimuscarinic subgroups showed that median time to discontinuation was longest with solifenacin combinations (214 days) compared with other antimuscarinic combinations (range, 47-164 days; adjusted HR range, 1.27-1.77, p = 0.037). No observable impact on treatment persistence was found by adjusting the gaps used to define discontinuation. DISCUSSION: This study of real-world evidence of men with LUTS/BPH treated with alpha-blocker plus antimuscarinic combination therapy in the Netherlands showed that treatment persistence was significantly greater in those who received a FDC tablet compared with combination therapy given concomitantly. The study also shows that treatment persistence was extended in men who received combination therapy containing solifenacin compared with other antimuscarinics. CONCLUSIONS: Overall, these findings may be useful for prescribers, as improved persistence on-treatment may translate into improved outcomes for men with LUTS/BPH. Further study is warranted to establish the key drivers of persistence in men receiving combination therapy for LUTS/BPH.

https://www.doi.org/10.1186/s12894-017-0226-2