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Mirabegron is alternative to antimuscarinic agents for overactive bladder without higher risk in hypertension: a systematic review and meta-analysis

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Abstract

Purpose

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.

Materials and methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

This study was supported by grants from the Kaohsiung Municipal Ta-Tung Hospital (KMTTH-105-034).

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Authors and Affiliations

  1. Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

    Hsiao-Ling Chen, Hsiu-Mei Chang, Wei-Hsuan Huang, Hung-Fang Pan, Yong-Chieh Chang & Chiou-Mei Wu

  2. Division of Infectious Diseases, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

    Tun-Chieh Chen

  3. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, No.68, Jhonghua 3rd Rd, Cianjin District, Kaohsiung, 80145, Taiwan

    Yung-Shun Juan & Hsiang Ying Lee

  4. Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Ya-Ling Wang

  5. Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hsiang Ying Lee

  6. Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Hsiang Ying Lee

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  1. Hsiao-Ling Chen
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Contributions

HLC, HYL: literature search and the data extraction. HLC: protocol/project development, data management, and manuscript writing. HYL: protocol/project development, data analysis, and manuscript writing. TCC: protocol/project development, and data analysis. HMC: protocol/project development, and data collection. SJY: protocol/project development, and data collection. WHH: protocol/project development, and data collection. HFP: protocol/project development, and data collection. YCC: protocol/project development, and data collection. CMW: protocol/project development, and data collection. YLW: protocol/project development, and data collection.

Corresponding author

Correspondence to Hsiang Ying Lee.

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The authors declare no competing financial interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Chen, HL., Chen, TC., Chang, HM. et al. Mirabegron is alternative to antimuscarinic agents for overactive bladder without higher risk in hypertension: a systematic review and meta-analysis. World J Urol 36, 1285–1297 (2018). https://doi.org/10.1007/s00345-018-2268-9

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  • DOI: https://doi.org/10.1007/s00345-018-2268-9

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