Presented by: Ijeoma Nnorom MBBS, MRCS
King's College Hospital London

Introduction

This study aims to compare the prescribing choices of medications for female lower urinary tract symptoms (LUTS) to self-administration preferences of Urologists and associated practitioners across the globe. The medications included in the survey are recommended by international guidelines, and data on their properties including efficacy and side effect profile are largely drawn from trials. According to the European Association of Urology (EAU), one systematic review showed no statistically significant difference in effectiveness between Mirabegron and Solifenacin at relieving symptoms, though at one year follow up, symptom reduction lay in favour of Mirabegron. Also, some studies among anticholinergics reveal no significant difference in in efficacy between them, but conflicting reports on this have been obtained from yet other studies with equally high levels of evidence.

There is a paucity of data regarding the physician's take on these medications against the backdrop of existing data on efficacy and side effect profile, as well as (guideline) recommendations for their use. The personal (self prescription) preferences discovered may throw some light on clinicians' approval of these medicines. We also wanted to assess the tendencies of our colleagues in other parts of the globe who may use a different set of guidelines and/or have a varying array of medications accessible to them in comparison to those commonly used in United Kingdom (UK) practice.

Materials

An electronic survey of Urologists and allied practitioners, practicing within the United Kingdom (UK) and globally was conducted. On a 10-point Likert scale, respondents were asked 3 questions about these medications: ‘Likelihood of prescribing’; the ‘perceived efficacy’, and ‘the likelihood of the respondent taking them’.

6 agents were considered- Duloxetine, Solifenacin, Fesoterodine, Oxybutinin- Immediate Release (IR), Oxybutininin Extended Release (ER), and Mirabegron.

Results

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Of the 119 respondents, most were from the UK (83%). 81% were Urologists and 14% Urology trainees.

Mirabegron was the most preferred prescription for patients with 30% being ‘Extremely likely’ to prescribe it, whereas half were ‘Extremely unlikely’ to offer Duloxetine (least preferred choice). Up to 81% of practitioners >/= the weighted average of 8 were happy to prescribe this to female patients. Next most preferred (for patients) was Solifenacin with nearly 2/3rds of practitioners favorably disposed. 

The most available medication (17 respondents) was Mirabegron and none of them said it was unavailable in their countries of practice while the hardest to come by was Fesoterodine in at least 57% of respondents' countries.

In terms of efficacy, again, Mirabegron was a winner with relief of symptoms, followed closely by Solifenacin among 78% and 71% (>/= respective weighted averages) of respondents. Duloxetine was deemed to have the least efficacy (42% >/= 3). Among antimuscarinics, oxybutinin (IR) ranked lowest, and there was no perceived variation in efficacy between Fesoterodine and Oxybutinin (ER).

Self prescribing patterns were largely similar to patient prescribing patterns. A slight variation was noted with Solifenacin and Mirabegron. These 2 remained the most preferred choice. Howbeit among physicians, solifenacin would be the better option.

Overall, Duloxetine was the least preferred choice for patients, for self and was deemed the least effective at relieving symptoms.

 

Conclusion

The prescribing choices of Urologists for female LUTS management largely mirror their personal preferences, a contrast to findings in the male LUTS study. The results obtained from this study can drive future studies on the actual factors which dictate prescribing choices in various climes- side effect profile, cost and payment methods, demographics, prevalent local prescriptions and more. Furthermore, more robust studies may provide much needed information which could drive development of future medication and prescribing climates that enhance desirable characteristics and minimize unfavorable ones.

Funding

None (Self funded)

Co-Authors

Francesca Kum, FRCS
King's College Hospital London

Gordon Muir, FRCS
King's College Hospital London