Overactive bladder syndrome (OAB) management with pharmacotherapy is limited by low real-world adherence and persistence. The use of β3-adrenergic receptor agonists has shown improved persistence compared with anticholinergics [1]. Vibegron, a β3-adrenergic receptor agonist approved in December 2020 for OAB, showed efficacy and safety in the 12-week EMPOWUR trial [2] and its 40-week extension [3]. This analysis compared real-world adherence and persistence of patients initiating vibegron with mirabegron and anticholinergics.

This retrospective study used pharmacy claims data from the Optum Research Database. Study criteria included patients ≥18 years old with ≥1 pharmacy claim for vibegron, mirabegron, or an anticholinergic (darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, trospium) from April 1, 2021, to December 31, 2021 (identification period); continuous enrollment in a commercial or Medicare Advantage health plan with pharmacy and medical benefits for 3 months preindex (baseline) and ≥2 months postindex (follow-up period); and no index medication during baseline. Two independent propensity-score models were used to match patients treated with (1) vibegron vs mirabegron and (2) vibegron vs anticholinergics. Patients were matched in a 1:2 ratio for each comparison group. Adherence was measured by proportion of days covered (PDC) from index to end of follow-up, and adherent patients were defined as PDC ≥80%. Persistence was defined as days to discontinuation of index medication (first 30-day gap) or end of follow-up. Adherence and persistence were analyzed descriptively and by Kaplan-Meier analysis, respectively.

After matching, 1655 and 3310 patients were included in the matched vibegron and mirabegron cohorts, respectively, and 1595 and 3190 patients were included in the matched vibegron and anticholinergic cohorts. Cohorts were generally well balanced with respect to age, gender, and race. Patients receiving vibegron had greater adherence compared with patients receiving mirabegron (mean [SD] PDC: 0.71 [0.31] vs 0.68 [0.32], respectively; P=0.004) and compared with patients receiving anticholinergics (mean [SD] PDC: 0.71 [0.31] vs 0.61 [0.35]; P<0.001). A greater percentage of patients receiving vibegron were adherent compared with those receiving mirabegron (53.4% vs 49.2%, respectively; P=0.005) and compared with those receiving anticholinergics (53.7% vs 43.2%; P<0.001). Persistence was longer with vibegron vs mirabegron (median [95% CI]: 205 [162–246] vs 148 [126–162] days, respectively; P<0.001) and vs anticholinergics (207 [167–246] vs 91 [91–95] days; P<0.001) (Figure). A greater percentage of patients receiving vibegron remained persistent through the end of the study period compared with patients in the matched mirabegron cohort (56.8% vs 50.8%, respectively; P<0.001) and matched anticholinergics cohort (56.9% vs 42.9%; P<0.001).

In this retrospective analysis, real-world adherence and persistence was higher in patients initiating vibegron compared with patients initiating mirabegron or anticholinergics when matched on baseline characteristics. However, interpretation of results is limited by the inability to confirm if patients who were prescribed medications took the medication or if behavioral therapy was implemented. Further, as with retrospective datasets, these results may not be generalizable to all patients with OAB.

Vibegron demonstrated greater adherence and longer persistence relative to other OAB pharmacologic options in this retrospective analysis; however, the potential clinical impact for patients with OAB requires further study.

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