LAUSR

In this issue of European Urology, Chapple et al [1] report on persistence rates and median time to discontinuation for a number of drugs routinely prescribed for overactive bladder (OAB). The report raises some important questions. (1) How bad are these rates, how do they compare with agents in other fields, and what factors influence these rates? (2) Is mirabegron really superior to the other OAB agents in these categories and, if so, why? Persistence data are disappointing in general, and worse for agents prescribed for OAB. Yeaw et al [2] summarized 6mo persistence and adherence rates for drug therapy for six chronic conditions: prostaglandin analogs (eye drops), 47%; statins, 56%; bisphosphonates, 56%,;oral diabetic medications, 66%; angiotension receptor blockers, 63%; and OAB medications (all antimuscarinics at that time), 28%. At 1 yr, these rates decreased to 32%, 43%, 41%, 54%, 50%, and 18%, respectively. The spread between persistence rates became evident after 90 d of therapy, after which relative rates were stable and declined consistently to the study end. Interestingly, patients taking prostaglandin eye drops for glaucoma and those taking OAB medications showed the earliest rapid declines. Eye drops are in a special category because of the potential difficulty and nuisance in administering them, but other factors cited for nonadherence seemed to be common to all groups and include poor patient-physician communication, poor patient education, lack of efficacy, adverse events, and costs. Specifically related to the treatment of OAB with antimuscarinics, the most important patient reasons for discontinuing medications are consistently reported as unrealistic expectations regarding efficacy and side effects [3]. Other reasons include patients learning to get by without medication, improved or ‘‘cured’’ symptoms, and