Open AccessA retrospective analysis comparing persistence and adherence to treatment with free‐ vs fixed‐dose combination of an alpha blocker and an antimuscarinic agent in men with LUTS in Spain
Author(s) -
Landeira Margarita,
Mora Blázquez Ana M.,
Martins de Almeida Rodrigo,
Covernton Patrick J. O.,
MedinaPolo José,
Montero Antonio Alcántara
Publication year - 2020
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.13616
Subject(s) - medicine , persistence (discontinuity) , alpha (finance) , medication adherence , retrospective cohort study , surgery , patient satisfaction , geotechnical engineering , engineering , construct validity
Combination therapy with an alpha blocker (AB) plus an antimuscarinic (AM) is recommended for men with moderate‐to‐severe mixed lower urinary tract symptoms (LUTS) when monotherapy is not effective in relieving storage symptoms. This study compared treatment persistence and adherence with an AB plus AM fixed‐dose combination (FDC) vs an AB plus AM free‐dose combination in men with LUTS in Spain. Methods Retrospective study using the Spanish IQVIA Cegedim Electronic Medical Records database. Men prescribed AB plus AM combination therapy were included in an FDC or free‐dose combination cohort based on their index treatment. Treatment persistence was the time from index date to first discontinuation of ≥1 of the two index drugs over 12 months. Adherence was measured using the fixed medication possession ratio (MPR). Results Of 3114 patients identified, 999 were included (FDC, n = 790; free‐dose combination, n = 209). Median (95% CI) persistence was longer in the FDC (125 [109‐151] days) than in the free‐dose combination (31 [31‐36] days) cohort (hazard ratio [HR], 2.9; 95% CI, 2.4‐3.4; P < .0001). The 12‐month persistence rates were 31.1% (FDC cohort) and 8.9% (free‐dose cohort). The mean (SD) fixed MPR was higher in the FDC cohort (48.8 [37.2]) compared with the free‐dose cohort (23.1 [28.4]); more patients in the FDC cohort (34.2%) than in the free‐dose cohort (10.0%) were adherent (MPR ≥ 80%). The probability of treatment persistence and adherence increased with age (>80 vs <65 years, persistence HR, 0.7 [95% CI, 0.5‐0.9]; MPR difference, 12.5), polypharmacy (persistence HR, 0.7 [95% CI, 0.6‐0.9]; MPR difference, 10.7) and previous use of AB (persistence HR, 0.8 [95% CI, 0.7‐1.0]; MPR difference, 5.7) or AB/AM combinations (persistence HR, 0.7 [95% CI, 0.5‐0.9]; MPR difference, 11.1). Conclusions Treatment with an AB/AM FDC is associated with better persistence and adherence vs a free‐dose combination in men with LUTS in Spain.