Comparative assessment of onabotulinumtoxinA and mirabegron for overactive bladder: an indirect treatment comparison

Abstract

ContextOnabotulinumtoxinA and mirabegron have recently gained marketing authorisation to treat symptoms of overactive bladder (OAB).ObjectiveTo evaluate the relative efficacy of mirabegron and onabotulinumtoxinA in patients with idiopathic OAB.DesignNetwork meta-analysis.Data sourcesA search of 9 electronic databases, review documents, guidelines and websites.MethodsRandomised trials comparing any licensed dose of onabotulinumtoxinA or mirabegron with each other, anticholinergic drugs or placebo were eligible (19 randomised trials were identified). 1 reviewer extracted data from the studies and a second reviewer checked the data. Candidate trials were assessed for similarity and networks were developed for each outcome. Bayesian network meta-analysis was conducted using both fixed-effects and random-effects models. When there were differences in mean baseline values between mirabegron and onabotulinumtoxinA trials they were adjusted for using network meta-regression (NMR).ResultsNo studies directly comparing onabotulinumtoxinA to mirabegron were identified. A network was created for each of the 7 outcomes, with 3–9 studies included in each individual network. The trials included in the networks were broadly similar. Patients in the onabotulinumtoxinA trials had more urinary incontinence and urgency episodes at baseline than patients in the mirabegron trials and these differences were adjusted for using NMR. Both onabotulinumtoxinA and mirabegron were more efficacious than placebo at reducing the frequency of urinary incontinence, urgency, urination and nocturia. OnabotulinumtoxinA was more efficacious than mirabegron (50 and 25 mg) in completely resolving daily episodes of urinary incontinence and urgency and in reducing the frequency of urinary incontinence, urgency and urination. NMR supported the results of the network meta-analysis.ConclusionsIn the absence of head-to-head trials comparing onabotulinumtoxinA to mirabegron, this indirect comparison indicates that onabotulinumtoxinA may be superior to mirabegron in improving symptoms of urinary incontinence, urgency and urinary frequency in patients with idiopathic OAB.

Urinary incontinence in women

“…In licensing trials, mirabegron was tested against placebo and tolterodine (an antimuscarinic), and subsequent post-marketing trials tested it against, and in combination with, several anticholinergics 136,137 . Meta-analyses have shown similar efficacy to available anticholinergic drugs, but with a much reduced incidence of dry mouth 138,139 , and lower efficacy than intravesical onabotulinumtoxinA 140 . Mirabegron has the potential to exacerbate hypertension 131 , but is otherwise well tolerated compared with most anticholinergics, with good persistence 141 .…”

Urinary incontinence in women

“…In licensing trials, mirabegron was tested against placebo and tolterodine (an antimuscarinic), and subsequent post-marketing trials tested it against, and in combination with, several anticholinergics 136,137 . Metaanalyses have shown similar efficacy to available anticholinergic drugs, but with a much reduced incidence of dry mouth 138,139 , and lower efficacy than intravesical onabotulinumtoxinA 140 . Mirabegron has the potential to exacerbate hypertension 131 , but is otherwise well tolerated compared with most anticholinergics, with good persistence 141 .…”

Comparative Efficacy and Safety of Dupilumab and Benralizumab in Patients with Inadequately Controlled Asthma: A Systematic Review

“…In this analysis, we performed an indirect comparison by using statistical methods of Bayesian network meta-analysis with the random effect model. This statistical method is considered to be a well established statistical method of ITC [53,54], and in a broad range of fields, many reports of ITC using this statistical method have been described previously [55][56][57][58][59][60][61]. An analysis was performed not only in the overall population, but in the limited population with blood eosinophils of ≥300, ≥150 but <300, and <150 as subgroup analysis.…”