Overactive bladder (OAB) is defined as 'urinary urgency with or without urinary urgency incontinence (UUI), usually associated with urinary frequency and/or nocturia, in the absence of urinary tract infection'. OAB is known to be a common disorder with a significant impact on quality of life. First line treatments include weight loss in those with a BMI > 30, bladder retraining and fluid advice. Pharmacotherapy treatment includes antimuscarinics and mirabegron, a beta 3 agonist. The National Institute of Clinical Excellence (NICE), has recently incorporated the use of a newer beta 3 agonist, vibegron, into its recommendations for the management of overactive bladder (OAB). There are no head-to-head studies which directly compare the efficacy of vibegron with mirabegron, an older beta 3 agonist.
This network meta-analysis aims to compare the safety and efficacy of vibegron when compared to mirabegron and tolterodine, more longstanding treatments for OAB.
A systematic review was conducted to identify phase III randomised controlled trials, for patients with idiopathic OAB, which compared mirabegron and/or vibegron and/or tolterodine. The primary outcome was the change from baseline in episodes of urinary urgency (UU). The secondary outcomes assessed were:The study was registered on PROSPERO (CRD 420250636077) and analysis was performed using MetaInsight.
Of the 2,647 identified articles, five studies were deemed suitable to include in the network meta-analysis. Results for the primary outcome included 5,317 patients and demonstrated a greater improvement in UU episodes in the vibegron group, when compared to placebo, tolterodine and mirabegron. Vibegron also ranked favourably in reduction in episodes of UUI and improvement in maximum voided volume per void. Whereas mirabegron had the greater improvement in reduction in episodes of urinary frequency.
The incidence of any adverse event was highest in the vibegron group. Tolterodine had the highest rate of hypertension and dry mouth. Constipation was highest in the vibegron group. However, it is important to note the large heterogeneity in definitions of adverse events as well as discrepancy in their reporting.
Vibegron appears to rank more favourably for improvement in episodes of UU, UUI and maximum voided volume per void, when compared to mirabegron and tolterodine. Mirabegron ranks more favourably for improvement in episodes of urinary frequency over 24 h. Mirabegron is least likely to be associated with hypertension, although reporting of adverse events is non-standardised and therefore may not be comparable. This network meta-analysis does not account for other factors which may influence drug therapy choice i.e. contraindications, difficulties with swallowing and available treatment options.
European journal of obstetrics, gynecology, and reproductive biology. 2026 Jul 21 [Epub ahead of print]
R Mohamed-Ahmed, A Rantell, D Robinson
King's College London, United Kingdom; Department of Urogynaecology, King's College Hospital, London SE5 9RS, United Kingdom. Electronic address: ., Department of Urogynaecology, King's College Hospital, London SE5 9RS, United Kingdom. Electronic address: ., King's College London, United Kingdom; Department of Urogynaecology, King's College Hospital, London SE5 9RS, United Kingdom. Electronic address: .