Overactive bladder is a chronic condition characterized by symptoms of urinary urgency, often accompanied by frequency and nocturia, with or without urinary incontinence. More than half of patients (pts) with overactive bladder are inadequately treated with anticholinergic therapy and may require later-line therapy. This analysis evaluated patient characteristics and real-world persistence among pts with overactive bladder receiving later-line treatment.

This retrospective cohort analysis examined the IBM MarketScan Commercial and Medicare Supplemental Database (01/01/2016 – 09/30/2020). Adults (≥18 y at index date) with a diagnosis of overactive bladder (≥1 inpatient or ≥2 outpatient medical claims ≥60 days apart) were included if they had ≥1 claim (earliest claim = index date) for either onabotulinumtoxinA (onabotA), mirabegron, or percutaneous tibial nerve stimulation. Continuous enrollment in medical/pharmacy benefits was required for 1 y prior to and not including the index date and for ≥14 months after the index date. A 14-month post-index window was selected to allow for the 6–7 month retreatment interval used with onabotA in clinical practice. Pts using onabotA, mirabegron, percutaneous tibial nerve stimulation, or toxins other than onabotA before the index date, or with a neurogenic bladder diagnosis were excluded. Persistence was defined as ≥2 injections in the 14 months post-index date to allow a 30-day gap between injections (onabotA); continuous prescription claims with no gaps ≥30 days (mirabegron); and an average of ≥12 injections in the 12 weeks post-index date followed by 1 treatment/month with no gaps ≥30 days (percutaneous tibial nerve stimulation). A sensitivity analysis was performed with alternate persistence definitions for mirabegron and percutaneous tibial nerve stimulation that were more similar to how persistence was defined for onabotulinumtoxinA.

Of 10,261 pts in this analysis, 698 used onabotA, 9249 used mirabegron, and 314 used percutaneous tibial nerve stimulation. At baseline, mean age was similar between the onabotA and mirabegron groups and higher in the percutaneous tibial nerve stimulation group (61.1, 62.7, and 77.8 y, respectively) as was baseline mean Charlson Comorbidity Index (1.5, 1.5, and 2.3). The percentage of pts with a commercial insurance plan differed among the 3 groups (68%, 61%, and 3%, respectively). Persistence rate at 14 months post-index date was highest in the onabotA group (45.8%; P<0.0001; Figure 1).

The results of this analysis suggest that OAB patients starting on onabotA are more likely to continue with treatment through 14 months when compared to mirabegron and PTNS. While a multitude of factors may contribute to the observed persistence including but not limited to increased effectiveness, tolerability, and patient satisfaction, the exact reason(s) cannot be determined from this study.

Among pts with overactive bladder initiating later-line therapy, onabotA had a higher persistence rate at 14 months post-index date compared with mirabegron and percutaneous tibial nerve stimulation.