A Prospective, non-intErventional Registry Study of PatiEnts initiating a Course of drug Therapy for overactIVE bladder (PERSPECTIVE): Rationale, Design, and Methodology– Beyond the Abstract

Factors contributing to individual patient compliance or non-compliance with oral pharmacotherapies for overactive bladder (OAB) are diverse1.   And, as compared to many other conditions, long-term adherence is comparatively poor2.   Whether the introduction of a new class of well-tolerated agents, the beta 3 agonists, (currently represented in the US only by mirabegron but with others in development), will alter this landscape is unclear.   Nevertheless, much of the available data regarding compliance with OAB medications comes from retrospective studies or retrospective inquiries into large insurance company, health plan or government databases.  Such data is quite limited in the ability to draw substantive, meaningful conclusions.  It is clear that compliance with oral pharmacotherapy for OAB is critical for long-term management of the condition.  Symptoms often return or progress following cessation of therapy3.  Therefore, understanding the reasons for discontinuing therapy may provide an opportunity for addressing these issues and improving patient care. 

This sponsored study from multiple sites in North America is the first “real world” prospective inquiry into reasons underpinning the initiation and selection of agents between classes, as well as causes for switching or discontinuing therapy.  The study is completely non-interventional in that neither the prescriber or patient is incentivized to choose between agents or start or stop any particular therapy.  Over 1500 patients have been entered into the trial with preliminary demographic data having been presented at the International Continence Society meeting in 2017 in Florence, Italy4.  Data continues to accrue which should provide some insights into OAB pharmacotherapy patterns of initiation, persistence, and discontinuation. 

References:
  1. Benner, J.S., Nichol, M.B., Rovner, E.S., et al: Patient-reported reasons for discontinuing overactive bladder medication.  BJU Int.105(9):1276-82, 2010
  2. Yeaw, J. et al.  J. Managed Care Pharm. 15:728-740,  2009
  3. Choo, M-S, et al: Changes in overactive bladder symptoms after discontinuation of successful 3- month treatment with an antimuscarinic agent: a prospective trial. J.  Urol. 174: 201–204,  2005
  4. Rovner, E., Nair, K., Carlson, K., Oakkar, E., Park, J.< Velentgas, P., Kristy, R., Gooch, K., Schermer, C.: Baseline characteristics of patients initiating mirabegron or antimuscarinic treatment for overactive bladder: results from the PERSPECTIVE registry. ICS Meeting, Florence Italy, Sept. 2017
Written by: Eric S. Rovner, MD, Professor of Urology, Department of Urology, Medical University of South Carolina. Charleston, SC
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