Long-term effectiveness of an intervention to enhance mirabegron use revision and its deprescribing: 36-month follow-up of a quasi-experimental trial in primary care

Abstract

Objective

This is a follow-up study from a multicenter, prospective, before-and-after quasi-experimental, controlled trial to assess effectiveness at 36 months of an intervention designed to promote the revision and deprescribing of mirabegron in primary care in patients with overactive bladder.

Methods

Intervention included patients who attended in 17 PHCs located in North Barcelona; control included patients who attended in the other 34 PHCs located in South, East and West Barcelona. The primary endpoint was mirabegron review and deprescribing when GPs considered appropriate, which was measured by the percentage of change of the number of patients with treatment at 36 months compared to the baseline. The intervention consisted of meetings with all the directors of the PHCs; distribution of the infographic to the GPs; providing information regarding the intervention for urologist and gynaecologist; and review of the treatments by the GPs. A monthly follow-up was done during the first year, and every three months thereafter until month 36.

Results

Overall, 1932 patients were included, mean age 71.6 years (female 53.8%). A total of 540 patients included in the intervention discontinued mirabegron at some point during the 36 months follow-up (540/762, 70.8%) compared to 759 patients in the control (759/1170, 64.9%), (p < 0.001). A total of 324/433 patients (74.8%) who discontinued mirabegron use at 12 months remained without pharmacological treatment at 36 months. With respect to the baseline cohort, there was a lower introduction of new patients with mirabegron in the intervention (546/762, 71.6%) compared to the control (1246/1170, 106.5%), (p < .001). Regarding the treated patients, there was an increase of 41.6% in the control and a slight increase of 0.8% in the intervention at 36 months, (p < .001).

Conclusion

Our data indicate that an intervention can enhance the review use of mirabegron in the primary care setting, and promote their deprescribing.

Keywords:

• Mirabegron
• overactive bladder
• patient-centred care
• deprescribing
• persistence

Transparency

Declaration of funding

This work was supported by the Gerència Territorial de Barcelona, Catalan Institute of Health under Grant number XB2018.

Declaration of financial/other relationships

The authors declare that they have no competing interests. A reviewer on this manuscript has disclosed having received payment from the manufacturers of mirabegron (Astellas) for consultancy, speaking and research in the past. Another reviewer declares having conducted Research and Consultancy activities for Astellas and Allergan. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

All individuals listed as authors have contributed substantially to the study concept and design, analysis an interpretation of the data, and critical revision of the manuscript the concept and preparation of this manuscript. EFL drafted the manuscript. All authors read and approved the final manuscript.

Acknowledgements

To all the directors and the physician leaders of PHCS Muntanya (Pilar Algueró, Raquel Burón, Ramon Ravella, Marta Badia, Oriol Caixés, Angel Cano, Montserrat Espuga, Isabel Garrido, M. Angeles Hortelano, Joan Juvanteny, Paco Luque, Alicia Marco, Agnès Martí, María Martínez, Judit Méndez, Manel Milian, Marta Muntane, Jordi Acezat, Cristina Boté, María Atero, Carme Rodrigo, Laura Rubio, Elisabeth Solf, Trinitat Tovar, Carmen Troyano) without their help, this study could not have been carried out. No assistance in the preparation of this article is to be declared.