Persistence with solifenacin add-on therapy in men with benign prostate obstruction and residual symptoms of overactive bladder after tamsulosin monotherapy

Abstract

AimsIn spite of the reported efficacy and safety of antimuscarinics in men with OAB (overactive bladder) and BPO (benign prostatic obstruction), many patients do not persist with the treatment. We aimed to evaluate persistence and the reasons for the discontinuation of solifenacin add-on therapy in men with residual symptoms of OAB after tamsulosin monotherapy for BPO in a real clinical environment. MethodsMen aged 45years with IPSS 12 and symptoms of OAB (OAB-V8 8, micturition 8/24h, urgency 2/24h) were prescribed tamsulosin 0.2mg. After 4weeks, men who had residual symptoms of OAB (OAB-V8 8, micturition 8/24h, urgency 1/24h) and reported that they were dissatisfied' or a little satisfied' with the therapy were enrolled and prescribed solifenacin 5mg in combination with tamsulosin. After 52weeks, persistence and the reasons for the discontinuation of solifenacin were evaluated. Factors related to persistence were analysed. ResultsOf the 305 men who had been treated with tamsulosin, 176 were prescribed solifenacin. After 52weeks, 44 (25%) remained on solifenacin therapy. Of the 132 who discontinued solifenacin, 85 were evaluated on the reason for discontinuation. The three most common reasons for discontinuation were adverse events (AEs) (35%), lack of efficacy (33%), and improvement in symptoms (16%). The aggravation of voiding symptoms was the most common AE leading to discontinuation. Retention was observed in 11 men. None of the demographical or clinical characteristics were significantly related to persistence. ConclusionsOnly 25% men with OAB and BPO remained on antimuscarinic add-on therapy after 1year, mostly because of AEs and lack of efficacy. Realistic data should be added to what is already known about antimuscarinic treatment in men by including patients who were excluded or who dropped out of well-designed clinical trials.