Mirabegron, a β3-adrenoceptor agonist, was approved for overactive bladder (OAB), but worsened hypertension was a potential risk based on its mechanism of action. Besides, head to head comparisons were limited between mirabegron and antimuscarinic agents, the prior first-line pharmacotherapy of OAB. In this regard, we performed a systematic review and meta-analysis to compare their efficacy as well as safety, especially in blood pressure changes.
Literature search was conducted in PubMed, Medline and seven randomized clinical trial (RCT) register databases of WHO, EU, USA, Taiwan, China, Japan and Cochrane. Completed RCTs for OAB with mirabegron and antimuscarinics were identified and the last comprehensive search was run in August 2017. Cochrane risk of bias tool was used to assess the potential bias, and RevMan5 software was performed for meta-analysis.
Seven eligible RCTs (four for mirabegron vs. tolterodine and three for mirabegron vs. solifenacin) were included and demonstrated similar efficacy in micturitions, incontinence, and nocturia between mirabegron and antimuscarinics. In hypertension issue, no statistical differences were showed in risk ratio (RR) of hypertension events, change of blood pressure from baseline and change of blood pressure from placebo for all participants. On the other hand, RR of dry mouth was significantly lower in mirabegron users.
Mirabegron was not inferior effective in improving OAB symptoms compared with antimuscarinic agents. In addition, mirabegron presented lower incidence of dry mouth and not higher risk for hypertension. Therefore, mirabegron has potential to be an alternative therapeutic option for OAB control.
World journal of urology. 2018 Mar 19 [Epub ahead of print]
Hsiao-Ling Chen, Tun-Chieh Chen, Hsiu-Mei Chang, Yung-Shun Juan, Wei-Hsuan Huang, Hung-Fang Pan, Yong-Chieh Chang, Chiou-Mei Wu, Ya-Ling Wang, Hsiang Ying Lee
Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan., Division of Infectious Diseases, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan., Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, No.68, Jhonghua 3rd Rd, Cianjin District, Kaohsiung, 80145, Taiwan., Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan., Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, No.68, Jhonghua 3rd Rd, Cianjin District, Kaohsiung, 80145, Taiwan. .