A retrospective analysis comparing persistence and adherence to treatment with free‐ vs fixed‐dose combination of an alpha blocker and an antimuscarinic agent in men with LUTS in Spain

INTRODUCTION: Combination therapy with an alpha blocker (AB) plus an antimuscarinic (AM) is recommended for men with moderate‐to‐severe mixed lower urinary tract symptoms (LUTS) when monotherapy is not effective in relieving storage symptoms. This study compared treatment persistence and adherence with an AB plus AM fixed‐dose combination (FDC) vs an AB plus AM free‐dose combination in men with LUTS in Spain. METHODS: Retrospective study using the Spanish IQVIA Cegedim Electronic Medical Records database. Men prescribed AB plus AM combination therapy were included in an FDC or free‐dose combination cohort based on their index treatment. Treatment persistence was the time from index date to first discontinuation of ≥1 of the two index drugs over 12 months. Adherence was measured using the fixed medication possession ratio (MPR). RESULTS: Of 3114 patients identified, 999 were included (FDC, n = 790; free‐dose combination, n = 209). Median (95% CI) persistence was longer in the FDC (125 [109‐151] days) than in the free‐dose combination (31 [31‐36] days) cohort (hazard ratio [HR], 2.9; 95% CI, 2.4‐3.4; P < .0001). The 12‐month persistence rates were 31.1% (FDC cohort) and 8.9% (free‐dose cohort). The mean (SD) fixed MPR was higher in the FDC cohort (48.8 [37.2]) compared with the free‐dose cohort (23.1 [28.4]); more patients in the FDC cohort (34.2%) than in the free‐dose cohort (10.0%) were adherent (MPR ≥ 80%). The probability of treatment persistence and adherence increased with age (>80 vs <65 years, persistence HR, 0.7 [95% CI, 0.5‐0.9]; MPR difference, 12.5), polypharmacy (persistence HR, 0.7 [95% CI, 0.6‐0.9]; MPR difference, 10.7) and previous use of AB (persistence HR, 0.8 [95% CI, 0.7‐1.0]; MPR difference, 5.7) or AB/AM combinations (persistence HR, 0.7 [95% CI, 0.5‐0.9]; MPR difference, 11.1). CONCLUSIONS: Treatment with an AB/AM FDC is associated with better persistence and adherence vs a free‐dose combination in men with LUTS in Spain.