Efficacy and safety of mirabegron for the treatment of neurogenic detrusor overactivity resulting from traumatic spinal cord injury: A prospective study

Abstract

Objective: To assess the clinical, urodynamic efficacy, and safety of mirabegron in patients with neurogenic detrusor overactivity (NDO) consequent to traumatic spinal cord injury (SCI). Methods: This prospective cohort study was performed between January 2018 and July 2019 and included adult patients with stable traumatic suprasacral SCI, performing clean intermittent catheterization (CIC), and demonstrating NDO on urodynamic study (UDS). A 3-day bladder diary was made at the baseline after which all patients were started on Mirabegron 50 mg. They were followed up at 6 weeks with a repeat bladder diary and UDS which were compared with those at the baseline. Results: A total of 30 patients (4 females, 26 males, mean age: 30.07 years) were included. After 6 weeks of treatment, 5 out of the 29 incontinent patients became completely dry. The mean frequency of CIC decreased from 6.63 at the baseline to 5.37 at 6 weeks (p = .002), the mean CIC volume increased from 275 ml to 341 ml (p = .0002), the mean number of incontinence episodes in between CIC reduced from 3.97 to 2.27 (p < .0001) and time from CIC to leakage increased from 1.73 h to 2.75 h (p < .0001). The mean cystometric capacity increased from 348 ml to 406 ml (p = .008) and the maximum amplitude of NDO decreased from 54 cm H 2 O to 41 cm H 2 O (p = .005) at 6 weeks. Only two patients reported new onset dry mouth. No major adverse events were noted and none discontinued treatment. Conclusion: Mirabegron is efficacious and safe in patients with NDO consequent to traumatic SCI.

The efficacy and safety of mirabegron for adult and child patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‐analysis

“…A total of 86 articles were included in the preliminary screening. After removing repeated articles and excluding articles that did not meet the inclusion and exclusion criteria, 10 studies with 314 participants were finally included 2,6–9,12–16 . Four retrospective and six prospective studies were taken into the analysis.…”

“…After removing repeated articles and excluding articles that did not meet the inclusion and exclusion criteria, 10 studies with 314 participants were finally included. 2,[6][7][8][9][12][13][14][15][16] Four retrospective and six prospective studies were taken into the analysis. The selection process was shown by a flowchart in Figure 1 and the basic information of these articles was presented in Table 1.…”

Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury

“…The activation of β 3 adrenergic receptors causes detrusor relaxation with reduced pressure and, therefore, improved bladder storage. It has been most thoroughly studied in males with LUTD due to benign prostate hyperplasia [ 7 , 42 ], and shows promise in SCI populations, with reduced urinary incontinence, increased bladder capacity and reduced cognitive side effects compared to anticholinergic agents [ 43 , 44 , 45 ]. It is associated with a mild increase in heart rate and blood pressure and may be avoided in patients with severe hypertension [ 7 , 42 ].…”

Clinical Utility of β3-Adrenoreceptor Agonists for the Treatment of Overactive Bladder: A Review of the Evidence and Current Recommendations

“…They observed significant improvement in bladder diary–derived variables, such as mean catheterization frequency, mean catheterization volume, and mean number of incontinence episodes, as well as in urodynamic parameters (mean cystometric capacity and maximum amplitude of detrusor pressure). 33 …”