Margulis AV, Linder M, Arana A, Pottegard A, Anveden-Berglind I, Bui CL, Kristiansen NS, Bahmanya S, McQuay LJ, Atsma WJ, Appenteng K, Franks B, de Vogel S, D'Silva M, Perez-Gutthann S, Hallas J. Patterns of use of antimuscarinic drugs to treat overactive bladder in Denmark, Sweden, and the United Kingdom. Poster presented at the 32nd ICPE International Conference on Pharmacoepidemiology & Therapeutic Risk Management; August 28, 2016. Dublin, Ireland. [abstract] Pharmacoepidemiol Drug Saf. 2016 Aug; 25(Suppl 3):653.

BACKGROUND: In December 2012, mirabegron, a drug with a novel mechanism of action to treat overactive bladder (OAB), was approved in Europe.

OBJECTIVES: We characterized users and patterns of use of available antimuscarinic OAB drugs in Denmark, Sweden, and the UK before the approval of mirabegron, as a component of a multidatabase safety study for these drugs.

METHODS: We identified new users of OAB drugs aged 18 years or older without cancer from the Danish National Registers (2004-2012, n=72,917), Swedish National Registers (2006-2012, n=130,944) and UK CPRD (2004-2012, n=119,912). Therapy episodes, created by concatenating prescriptions for the same drug with gaps up to 60 days, could end due to no refill or end of follow-up, drug switch, or add-on. We added 7 days to allow for suboptimal compliance (Sweden, UK). Users were followed until disenrollment, cancer or death.

RESULTS: Mean age was 66 years in Denmark and Sweden and 62 years in the UK. About 70% of UK patients and 60% of Danish and Swedish patients were female. In Denmark, of the 224,680 therapy episodes, 4% were darifenacin, 9% fesoterodine, 2% oxybutynin, 39% solifenacin, 35% tolterodine and 12% trospium. In Sweden, of the 240,141 therapy episodes, 8% were darifenacin, 13% fesoterodine, 5% oxybutynin, 35% solifenacin, 37% tolterodine, and 3% had more than one treatment. Trospium was not available. In the UK, of the 245,800 therapy episodes, 0.3% were darifenacin, 3% fesoterodine, 28% oxybutynin, 27% solifenacin, 26% tolterodine, 6% trospium, and 10% had more than one treatment. About half of the index episodes (the episode with which the patient entered the cohort) in the three populations consisted of one prescription. In Danish, Swedish and UK cohorts, 93%, 83% and 81% of episodes, respectively, ended because of no refill. Solifenacin was the drug most patients added on or switched to.

CONCLUSIONS: In these three cohorts of similar age and sex distributions, about half of the episodes consisted of one prescription, and most episodes ended due to no refill. The preferred drugs were tolterodine and solifenacin; oxybutynin use was minimal in Nordic countries compared to the UK.

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