Persistence and Adherence of Anticholinergics and Beta-3 Agonist for the Treatment of Overactive Bladder: Systematic Review and Meta-Analysis, and Network Meta-Analysis.

PURPOSE To investigate the persistence and adherence rate of overactive bladder medications and factors that affect these rates. MATERIALS AND METHODS Electronic English-language literature searches of the PubMed, Cochrane Library, and EMBASE databases from the earliest available date of indexing through May 21, 2019, using the MeSH (Medical Subject Headings terms) and Emtree (EMBASE subject headings). Primary measurement outcomes were overall persistence and adherence rate at 6, 12, 24, and 36 months in anticholinergics and mirabegron. Secondary outcomes were individual effect of each medication on persistence and adherence rate at 12 months, and moderating factors affecting the overall persistence and adherence rate at 12 months. RESULTS Pooled overall persistence rate at 12 months of OAB medications of anticholinergics and mirabegron was 0.218 (95% CI: 0.197-0.240). The pooled overall persistence rate at 12 months was 0.402 (95% CI: 0.277-0.528) in mirabegron, 0.249 (95% CI: 0.182-0.316) in solifenacin, and 0.220 (95% CI: 0.078-0.361) in fesoterodine. Overall adherence rate of OAB medications of anticholinergics and mirabegron was 0.589 (95% CI: 0.507-0.670). The pooled overall adherence rate at 12 months was 0.654 (95% CI: 0.528-0.781) in mirabegron, 0.784 (95% CI: 0.588-0.980) in solifenacin, 0.782 (95% CI: 0.652-0.911) in fesoterodine, and 0.679 (95% CI: 0.651-0.707) in imidafenacin. Persistence and adherence rates were associated with age, sex, anticholinergic exposure history, type of medication, study type, and study year. CONCLUSIONS Persistence and adherence rates were lower than previously reported and were associated with certain clinical and demographic factors.