Treatment Persistence and Adherence with Overactive Bladder Medications in Taiwan: A Retrospective Database Analysis

Patients receiving mirabegron had better persistence and adherence than those receiving antimuscarinics in Taiwan, with no significant differences in the risk of falls/fractures between mirabegron and antimuscarinics. These findings provided treatment patterns for overactive bladder pharmacotherapy and may support treatment decisions. Overactive bladder (OAB) is commonly treated with mirabegron or antimuscarinics, but real-world evidence on treatment persistence, adherence, and fall/fracture outcomes in Taiwan remains limited. To assess treatment persistence, adherence, and associated outcome rates of falls/fractures, in patients receiving OAB treatment with mirabegron or antimuscarinics in Taiwan. Retrospective, longitudinal, observational study of routine clinical practice within the Taiwanese National Health Insurance Research Database. Eligibility: age ≥20 years; ≥1 dispensing for a new OAB index drug (January 1, 2012 to December 31, 2018); continuous enrollment 1 year before and after index prescription date. OAB Treatment with mirabegron or antimuscarinics. Primary endpoint: treatment persistence (time to discontinuation TTD or switch) and adherence (proportion of days covered PDC); secondary endpoint: incidence of falls/fractures. Multivariate Cox proportional hazards analyses were applied to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), describing associations between treatment groups and outcomes. Overall, 1,954,544 patients were eligible (median age 60 years). Median (interquartile range IQR) TTD was longer with mirabegron (56 19–168 days) than antimuscarinics (14 5–42 days) (risk of discontinuation aHR 1.58 95% CI 1.55–1.61; p < 0.001). Median (IQR) PDC was significantly higher with mirabegron (0.18 0.06–0.52) than antimuscarinics (0.03 0.01–0.12; p < 0.001). Mirabegron and antimuscarinics had no statistically significant difference in the risk of composite falls/fractures (aHR 1.05 95% CI 0.91–1.20; p = 0.519), falls (1.33 0.66–2.68; p = 0.431), and fractures (1.04 0.90–1.19; p = 0.623). Persistence and adherence were significantly greater with mirabegron than antimuscarinics in patients receiving OAB treatment in Taiwan. No statistically significant association was observed for the incidence of falls/fractures between treatment groups. However, given the wide 95% CIs, the findings should not be interpreted as equivalence.