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과민성 방광의 치료를 위한 항콜린제와 베타3 의 지속성과 순응도 : 체계적 고찰 및 메타분석과 네트워크 메타분석 |
| 순천향대학교 서울병원 비뇨의학과교실¹ |
| 김도경¹, 박재준¹, 이현영¹, 박준영¹, 두승환¹, 김재헌¹, 양원재¹, 송윤섭¹ |
OBJECTIVE: To investigate the overall persistence and adherence rate of OAB medications and its related factors, and also to investigate with a specific objective of investigating the individual effect of each OAB medications on persistence and adherence rate.
Material and methods : A systematic review of the literature published until May 21, 2019 was performed using the PubMed/Medline, Embase and Cochrane Database. Among the 818 articles screened, 44 articles were selected for qualitative analysis and 33 articles (n=397,822) included for data synthesis and current analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).
Results : Thirty persistence trials were carried out with 322,691 participants (80 effect sizes with 12 treatments). Pooled overall persistence rate at 12 months of OAB medications of anticholinergics and mirabegron was 0.218 (95% CI: 0.197, 0.240). The pooled overall persistence rate at 12 months was 0.402 (95% CI: 0.277, 0.528) in mirabegron, 0.249 (95% CI: 0.182, 0.316) in solifenacin and 0.220 (95% CI: 0.078, 0.361) in fesoterodine. 7 adherence trials were carried out with 46,731 participants (25 effect sizes with 10 treatments). Overall adherence rate of OAB medications of anticholinergics and mirabegron was 0.589 (95% CI: 0.507; 0.670). The pooled overall adherence rate at 12 months was 0.654 (95% CI: 0.528, 0.781) in mirabegron, 0.784 (95% CI: 0.588, 0.980) in solifenacin, 0.782 (95% CI: 0.652, 0.911) in fesoterodine and 0.679 (95% CI: 0.651, 0.707) in imidafenacin. Network meta-analysis were carried out among 15 persistence trials with 237,602 participants (65 effect sizes with 12 treatments). Mirabegron recorded the highest persistence rate at 12 months. The pooled overall mean difference of persistence rate compared with mirabegron was -0.062 (95% CI: -0.112, -0.010) in solifenacin, -0.085 (95% CI: -0.133, -0.035) in tolterodine ER, and -0.095 (95% CI: -0.149, -0.036) in fesoterodine. All anticholinergics showed much lower persistence rate than mirabegron.
CONCLUSIONS: This study showed overall persistence and adherence rate of OAB medications, which was relatively lower than previously reported data. Those low persistence and adherence rates were associated with age, sex, anticholinergic exposure history, type of medication (anticholinergics and mirabegron), study type and study year. |
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keywords : Medication Adherence, Urinary Bladder, Overactive , Cholinergic Antagonists |
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