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Adherence to Oral Therapy for Urgency Urinary Incontinence: Results from the Anticholinergic Versus Botox Comparison (ABC) Trial

Visco, Anthony G. MD*; Brubaker, Linda MD, MS; Jelovsek, J. Eric MD, MMEd; Wilson, Tracey S. MD§; Norton, Peggy MD; Zyczynski, Halina M. MD; Spino, Cathie DSc**; Sirls, Larry MD††; Nguyen, John N. MD‡‡; Rahn, David D. MD§§; Meikle, Susie F. MD, MSPH∥∥; Nolen, Tracy L. DrPh¶¶For the Pelvic Floor Disorders Network

Female Pelvic Medicine & Reconstructive Surgery: January/February 2016 - Volume 22 - Issue 1 - p 24–28
doi: 10.1097/SPV.0000000000000215
Original Articles
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Objectives Medication adherence with urgency urinary incontinence (UUI) treatment is challenging and the best assessment methodology is uncertain. We sought to describe adherence with anticholinergic (AC) versus placebo (P) by comparing pill counts and MEMSCAP event data and to identify factors associated with adherence.

Methods The randomized controlled AC versus Botox Comparison trial of women with moderate to severe idiopathic UUI included 126 participants initiating AC plus P bladder injection and 121 receiving P pills plus Botox injection. Adherence data on 243 participants (124 AC and 119 P) were calculated by pill count and MEMSCAP data for each 2-month interval during the 6-month study that allowed for dose escalation/drug change. Overall composite adherence estimates were calculated using the average of both methods and weighted by the duration of each 2-month interval.

Results Treatment groups had no significant differences in dosing duration (P = 0.76) or mean adherence (AC, 83.3% [16.8] vs P, 84.8% [13.8]). Only 53% of women met the dichotomous outcome of more than 80% adherence during all intervals. Correlation between adherence by pill counts versus MEMSCAP decreased over time with pill counts demonstrating higher adherence than MEMSCAP (r = 0.53, 0.50, and 0.36 for each 2-month interval). Lower adherence was associated with higher baseline incontinence severity and better UUI quality of life for the AC group and with current smoking status in both groups.

Conclusions Adherence using pill counts and MEMSCAP was reasonably correlated and similar in both the AC and P groups. In the AC group, higher baseline incontinence severity and better UUI Quality of Life were associated with decreased adherence. Smokers were less adherent.

From the *Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC; †Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL; ‡Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH; §Department of Urology, University of Alabama at Birmingham, Birmingham, AL; ∥Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT; ¶Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; **Department of Biostatistics, University of Michigan, Ann Arbor; ††Department of Urology, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI; ‡‡Department of Obstetrics and Gynecology, Kaiser Permanente Downey, Downey, CA; §§Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; ∥∥Gynecologic Health and Disease Branch, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD and ¶¶RTI International, Research Triangle Park, NC.

Reprints: Anthony G. Visco, MD, Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Dr, Suite 310, Durham, NC 27707. E-mail anthony.visco@duke.edu.

The authors have declared they have no conflicts of interest.

Supported by grants from The Eunice Kennedy Shriver National Institute of Child Health and Human Development, (Duke: 2-U10-HD04267-12; Loyola: U10-HD054136; UAB: 2-U10-HD041261-11; Utah: U10-HD041250; Cleveland Clinic: 2-U10-HD054215-06; UCSD: 2-U10-HD054214-06; Pittsburgh: 1-U10-HD069006-01; UTSW: 2-U10-HD054241-06; University of Michigan: U01-HD41249; RTI: 1-U01-HD069010-01) and the National Institutes of Health Office of Research on Women's Health.

IND: BB 12,780.

This trial is registered at www.clinicaltrials.gov under Registration No. NCT01166438.

Medication adherence using pill counts and MEMSCAP are reasonably correlated.

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