Real-World Adherence and Persistence of Vibegron Versus Mirabegron and Anticholinergics in Patients With Overactive Bladder: A Retrospective Claims Analysis
Benjamin Chastek, MS1, Adam Carrera, PharmD2, Christina Landis, MPH1, Daniel Snyder, PhD2, Laleh Abedinzadeh, MD2, Tim Bancroft, PhD1, Jeffrey Nesheim, PharmD, MS2, David Staskin, MD3.
1Optum, Eden Prairie, MN, USA, 2Urovant Sciences, Irvine, CA, USA, 3Tufts University School of Medicine, Boston, MA, USA.
BACKGROUND: Overactive bladder (OAB) management with pharmacotherapy is limited by low real-world adherence and persistence. This analysis compared real-world adherence and persistence of patients initiating vibegron, a β3-adrenergic receptor agonist approved in December 2020 for OAB, with mirabegron and anticholinergics (ACHs).
METHODS: 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 ACH from April 1, 2021-December 31, 2021; 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); 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 ACHs. Adherence was measured by proportion of days covered (PDC) from index to end of follow-up and 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.
RESULTS: After matching, 1655 and 3310 patients were included in the matched vibegron and mirabegron cohorts, respectively; 1595 and 3190 patients were included in the matched vibegron and ACH cohorts. Cohorts were generally well balanced with respect to age, gender, and race. Patients receiving vibegron had greater adherence vs patients receiving mirabegron (0.71 vs 0.68, respectively; P=0.004) or ACHs (0.71 vs 0.61; P<0.001). A greater percentage of patients receiving vibegron were adherent vs those receiving mirabegron (53.4% vs 49.2%, respectively; P=0.005) or ACHs (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 ACHs (207 [167-246] vs 91 [91-95] days; P<0.001) (Figure).
CONCLUSIONS: In this retrospective analysis, real-world adherence and persistence was higher in patients initiating vibegron compared with patients initiating mirabegron or ACH when matched on baseline characteristics. 
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