Abstract
BackgroundCombination drug therapy for lower urinary tract symptoms (LUTS) is beneficial to selected patients and recommended by guidelines. Patterns of real-world LUTS drug use, especially combination drug therapy, have not been studied extensively. Moreover, further understanding of the recent landscape is required following the introduction of the beta-3-adrenoceptor agonist mirabegron in the UK in 2013 for overactive bladder (OAB). The objective was to describe mono- and combination drug therapy use for LUTS in patients in UK clinical practice.MethodsThis was a retrospective, descriptive, observational database study using UK Clinical Practice Research Datalink GOLD and linked databases. Men and women ≥ 18 years with a first prescription for any LUTS drug from 2014 to 2016 with ≥ 12 months continuous enrollment pre- and post-index date were included. Primary endpoints were mono- or combination drug therapy use for LUTS in male and female cohorts. Secondary endpoints were description of treatment prescribed, treatment persistence and patient demographics. Data were analyzed descriptively. Sub-cohorts were defined by drugs prescribed at index date.Results79,472 patients (61.3% male) were included, based on index treatments. Of all men, 82.5% received any benign prostatic obstruction (BPO) drug, 25.4% any OAB drug, and 7.9% any BPO drug plus any OAB drug. As either mono- or combination drug therapy, 77.1% received an alpha-blocker, 18.9% a 5-alpha reductase inhibitor, 23.9% an antimuscarinic agent, and 2.1% mirabegron. Of all women, 94.5% received any OAB drug, 6.0% duloxetine, and 0.5% any OAB drug plus duloxetine. As either mono- or combination drug therapy, 87.7% received an antimuscarinic, and 9.7% mirabegron. In men or women receiving OAB treatment, approximately 2.5% received combination drug therapy with an antimuscarinic agent and mirabegron. For OAB drug monotherapies, mirabegron had the highest persistence in both male and female cohorts.ConclusionsThis study provides a better understanding of the recent landscape of LUTS drug use in UK clinical practice. It highlights potential undertreatment of storage symptoms in men with LUTS and the low use of combination OAB treatments.
Highlights
Combination drug therapy for lower urinary tract symptoms (LUTS) is beneficial to selected patients and recommended by guidelines
The inclusion of fixed-dose combinations may Conclusions This study provides new real-world evidence suggesting that men with Lower urinary tract symptoms (LUTS) may be under-treated with pharmacotherapies that target storage symptoms
Around a quarter of the men being treated for any LUTS received treatment targeting storage symptoms and around 8% of men received a combination of benign prostatic obstruction (BPO)/overactive bladder (OAB) drugs for mixed symptoms
Summary
Combination drug therapy for lower urinary tract symptoms (LUTS) is beneficial to selected patients and recommended by guidelines. Lower urinary tract symptoms (LUTS) is an overarching term for symptoms in men and women, comprising storage, voiding and post-voiding components [1, 2]. In both men and women, storage LUTS are commonly attributed to overactive bladder (OAB) syndrome [1,2,3], which is defined as urinary urgency, usually with increased daytime frequency and/or nocturia, with/without urinary incontinence, and with no urinary tract infection or other detectable disease [1, 2, 4]. Pharmacological therapy for OAB/urgency urinary incontinence (UUI) includes antimuscarinic agents or the beta-3 agonist, mirabegron [7]. Women with LUTS can experience symptoms of both OAB and SUI [10], but there are no recommendations regarding combination therapy with OAB/UUI drugs for such patients
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