Adding mirabegron after intravesical onabotulinumtoxinA injection improves therapeutic effects in patients with refractory overactive bladder

Abstract

Objectives To investigate whether adding an anticholinergic or beta‐3 agonist can improve the therapeutic effect of intravesical onabotuliumtoxinA injection in patients with refractory overactive bladder (OAB). Methods Ninety OAB patients who received an intravesical 100‐U onabotulinumtoxinA injection 1 month previously were consecutively invited into a prospective, randomized, open‐label study. They were randomly adding on solifenacin 5 mg daily (QD) (30 patients), mirabegron 50 mg QD (31 patients), or no medication (29 patients, control). All enrolled patients completed a 3‐day voiding diary, Overactive Bladder Symptom Score (OABSS) and Urgency Severity Scale (USS) questionnaires, Global Response Assessment (GRA) scale, and uroflowmetry at baseline (1 month after intravesical onabotulinumtoxinA injection) and 3‐, 6‐, 9‐, and 12‐month follow‐up. The primary end point was the effective therapeutic outcome defined as no OAB wet during the 12‐month period. The secondary end point included changes of GRA, OABSS, and the parameters of the voiding diary at 3 months. Results The baseline data were comparable among the three groups. The percentage of OAB wet in the mirabegron‐added‐on group was significantly less than that in the solifenacin‐added‐on and onabotulinumtoxinA‐only groups at four different time points (P = .02). At 3 months, the changes of GRA, OABSS, USS, urge urinary incontinence, frequency, nocturia episodes, and functional bladder capacity in the mirabegron‐added‐on group were significantly greater than those in the other groups. No serious adverse events were reported. Conclusions Adding mirabegron could increase the therapeutic effects, mainly on OAB symptoms and GRA scale, after intravesical onabotulinumtoxinA injection in refractory OAB patients.

Factors Affecting the Success of Intravesical Onabotulinum Toxin a Injection in the Treatment of Idiopathic Overactive Bladder

“…In a study published by Kuo et al [14], OAB patients were divided into 3 groups according to the treatments given. While bladder botox was applied to one group, solifenacin and mirabegron pharmacotherapies were added to the treatment, respectively, after bladder botox was applied to the other groups.…”

Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A

“…However, the durability of detrusor BoNT-A injections for frail elderly patients with OAB might be shorter and the rates of adverse events are higher than those in younger adults and older adults without frailty [ 77 ]. Adding on mirabegron after BoNT-A injections could improve OAB symptoms and quality of life in patients with refractory OAB [ 78 ]. Considering the adverse effects of BoNT-A on voiding efficiency in elderly patients with neurogenic OAB, BoNT-A injection into the bladder base might decrease the occurrence of adverse events such as difficulty in urination, dysuria, large PVR, and urinary retention [ 79 ].…”

Clinical Application of Botulinum Neurotoxin in Lower-Urinary-Tract Diseases and Dysfunctions: Where Are We Now and What More Can We Do?

“…However, increasing age, a Botox dose of 200 U, higher body-mass index, and baseline UUI episodes were found to be associated with a shorter time to UUI recurrence after Botox injection [ 16 ]. In patients who have diminished Botox effect on OAB symptoms, adding mirabegron could increase the therapeutic effects, mainly on OAB symptoms and the Global Response Assessment scale [ 17 ].…”