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Real-world persistence and adherence to oral antimuscarinics and mirabegron in patients with overactive bladder (OAB): a systematic literature review
  1. Gillian Yeowell1,
  2. Philip Smith1,
  3. Jameel Nazir2,
  4. Zalmai Hakimi3,
  5. Emad Siddiqui2,
  6. Francis Fatoye1
  1. 1 Manchester Metropolitan University, Manchester, UK
  2. 2 Astellas Pharma Europe Ltd, Chertsey, UK
  3. 3 Astellas Pharma BV, Leiden, The Netherlands
  1. Correspondence to Dr Gillian Yeowell; g.yeowell{at}


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.

  • overactive bladder
  • persistence
  • adherence
  • antimuscarinics
  • β3 adrenergic receptor agonists
  • systematic literature review

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  • Contributors GY, PS, JN, ZH, ES and FF were involved in conceptualisation and design of the study and critical review of the manuscript. FF, PS and GY performed the data extraction. All authors approved the final manuscript as submitted.

  • Funding The study and medical writing support were supported by Astellas Pharma Global Development.

  • Competing interests JN and ES are employed by Astellas Pharma. FF has received a grant from Astellas for study design, data extraction and manuscript development. ZH was an employee of Astellas Pharma when the research was conducted

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The search strategy and all data supporting this study are provided as supplementary information accompanying this paper.

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