Mirabegron: a review of recent data and its prospects in the management of overactive bladder

Sacco, Emilio; Bientinesi, Riccardo

doi:10.1177/1756287212457114

Cited by 112 publications

(83 citation statements)

References 33 publications

(54 reference statements)

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“…A 12-month study comparing mirabegron and tolterodine ER 4 mg in OAB reported that dry mouth, which contributed to the improved cost-effectiveness of mirabegron in the current analysis, was more frequently observed with tolterodine ER 4 mg. 54,55 Anticholinergic side effects are also likely to affect medication persistence and adherence, which are reported to decrease one month after treatment initiation with antimuscarinics. 24,56 Medication persistence and adherence are also reported to be important drivers of cost-effectiveness 57 and early real-world evidence in Canada suggests that median treatment persistence is greater with mirabegron (299 days or 196 days) compared to different antimuscarinics (96-242 days or 70-100 days) in previously treated and treatment-naïve patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, mirabegron 50 mg significantly reduced the number of Grade 3 and 4 urgency episodes per day vs. placebo in SCORPIO and the mean change (-2.25) was similar to tolterodine ER 4 mg (-2.07). 29 Another assumption of the model was that OAB symptoms improve during the first three months of treatment and are stable thereafter; this is supported by data from the 12-month study comparing mirabegron and tolterodine ER 4 mg. 54,55 Another assumption was that patients who discontinued treatment would not switch to another drug. Although information on this aspect of patient management is limited, there are data indicating that the majority of patients discontinue drug therapy after their first treatment.…”

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

Herschorn¹,

Nazir²,

Ramos³

et al. 2017

CUAJ

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Introduction: This analysis compared the cost-effectiveness of once-daily regimens of mirabegron 50 mg and generic tolterodine ER 4 mg in a hypothetical cohort of previously treated patients with overactive bladder (OAB) in Canada. Methods: A Markov model was developed to represent different health states according to OAB symptoms (frequency, incontinence), presence/absence of adverse events (AEs; dry mouth, constipation, blurred vision), and treatment status (on-treatment, discontinue treatment, restart previous treatment). The time horizon used was one year, with monthly transitions between health states. The model was populated using data from a phase 3, placebo-controlled trial of mirabegron that included tolterodine as an active comparator (SCORPIO), as well as other published literature and expert opinion. Cost-effectiveness was calculated from Canadian public payer (based on Quebec list prices) and societal perspectives. Results: The incremental one-year cost per patient for mirabegron over tolterodine was $182 CAD and $157 CAD from the payer and societal perspectives, respectively. The incremental quality-adjusted life year (QALY) gain for mirabegron was 0.0066 when using EQ-5D health-state utilities. Mirabegron was cost-effective compared with tolterodine, from both payer and societal perspectives, and remained cost-effective vs. tolterodine across the majority of sensitivity analyses. The model was based on limited clinical trial evidence supplemented with expert opinion and assumptions; a select number of OAB symptoms, AEs, and direct and indirect medical costs associated with OAB; and a timeframe of only one year. Conclusions: From the payer and societal perspectives, the health economic model indicates that in Canada, mirabegron is a cost-effective treatment strategy compared with tolterodine, leading to improved health outcomes (QALYs) at an acceptable incremental cost. IntroductionOveractive bladder (OAB) is a bothersome condition with a relatively high prevalence in the general population. In a survey of over 16 500 subjects aged ≥40 years in six European countries, the prevalence of OAB was 16.6%.1 In a subsequent survey of over 19 000 subjects aged ≥18 years in Canada and Europe, the prevalence of OAB was 11.8%. OAB has a substantial negative impact on patients' health-related quality of life (HRQoL) and mental health. 5The cardinal symptoms -urgency with or without incontinence, usually associated with frequency, and nocturia 6 -interfere with basic activities of daily living, such as work, travel, sleep, interpersonal activities, sexual function, and physical activities. 7,8 Studies have often focused specifically on the impact of incontinence, but it has been shown that frequency and urgency, which are more prevalent, are as bothersome as urgency incontinence.1 In terms of mental health, it is estimated that approximately one-third of men and women with lower urinary tract symptoms may have comorbid clinical anxiety and/or depression. 9 In addition, it has been shown that the prevale...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

Herschorn¹,

Nazir²,

Ramos³

et al. 2017

CUAJ

View full text Add to dashboard Cite

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“…While the potential for CYP450 interactions exists, the presence of multiple metabolic pathways reduces the likelihood of clinical significance of each. So far, large placebo-controlled studies have shown mirabegron to be very effective in reducing incontinence episodes, micturitions in 24 hours, and urgency episodes versus placebo and tolterodine [24]. In a most recent meta-analysis comparing mirabegron to other antimuscarinics, the results showed similar efficacy with incidence of dry mouth similar to placebo [26].…”

Section: New Treatment Optionsmentioning

confidence: 98%

“…Mirabegron is an agonist at the β3 adrenergic receptor in the detrusor muscle. β3 accounts for 95% of all β-adrenergic receptors in the bladder [24]. Binding at this receptor facilitates smooth muscle relaxation, thus reducing urge, frequency, and incontinence episodes without systemic anticholinergic side effects [25].…”

Section: New Treatment Optionsmentioning

confidence: 99%

Pharmacologic Management of Overactive Bladder and Urge Incontinence: A Review of New and Old Treatment Options

2014

J Androl Gynaecol

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“…In particular, Mirabegron is a β3-adrenoreceptor agonist currently approved to treat overactive bladder. Phase II studies and four large-scale phase III multinational randomized, controlled trials have supported the efficacy of mirabegron in the clinical trial of patients with overactive bladder during 12 weeks and also for 12 months [112]. Surprinsingly, Mirabegron has been assigned to raise resting metabolic rate and BAT thermogenesis [113].…”

mentioning

confidence: 99%

Mitochondrial Actions for Fat Browning and Energy Expenditure in White Adipose Tissue

Pbm¹,

Lopes²,

Alonso-Vale³

2016

Journal of Obesity and Overweight

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Obesity can be defined as the disruption in the balance between fuel intake and energy expenditure in favor of energy conservation. Together with type 2 diabetes (T2DM), these are the two of the most prevalent diseases affecting modern societies, arising mostly by changes in eating habits and a sedentary lifestyle associated with poorly known genetic determinants. Obesity predisposes to the so-called metabolic syndrome, which includes inflammation, hypertension, T2DM and cardiovascular diseases [1]. Obesity is imposing an increasingly heavy burden on the world's population in rich and poor nations alike, with almost 30 percent of people globally now either obese (BMI ≥ 30) or overweight (BMI ≥ 25) [2]. In fact, the number of overweight and obese people rose from 857 million in 1980 to 2.1 billion in 2013 [2]. Recently, obesity and metabolic syndrome were associated with mitochondrial dysfunction and deranged regulation of metabolic genes [3]. Interestingly, mitochondria of obese individuals seem to be different from those of lean individuals. Mitochondria from obese individuals display lower energy-generating capacity, less defined inner membranes and reduced fatty acid oxidation (FAO) [4]. AbstractWhite adipose tissue (WAT) is an endocrine organ with crucial role in the development of obesity and related diseases. White adipocytes have less mitochondria than brown adipocytes; nevertheless, there is an increasing body of evidence showing that mitochondrial parameters play a relevant role in WAT physiology, such as proliferation, differentiation and triacylglycerol storage levels. These parameters comprise mitochondria turnover, oxidative capacity, uncoupling, reactive oxygen species levels and oxygen consumption. In addition, the existence of beige (brown in white) adipose tissue and the transdifferatiation of WAT in brown adipose tissue are intrinsically related to mitochondria activity. Herein we highlight that the concerted action of stimulated lipolysis, mitochondrial oxidative metabolism and uncoupling (futile cycle) can enhance WAT energy expenditure. We consider WAT mitochondrial function a promising target for the development of therapies tackling lipotoxicity, obesity and related diseases. White adipose tissue (WAT) is the main tissue linked to obesity. WAT represents around 10% of total body weight in lean adults and more than 50% in obese individuals [5]. WAT is composed of mature adipocytes and the stromal-vascular fraction that contains preadipose cells (or adipoblasts), fibroblasts, immune cells, and blood vessel-associated cells [6]. A single and large lipid droplet occupies most of the white adipocyte volume and WAT copes with obesity either expanding (hypertrophy) or recruiting new cells (hyperplasia) [7]. WAT secretes an array of peptide hormones called adipokines (including leptin and adiponectin), which regulate neurological activities such as appetite and behavior, metabolic activities of peripheral tissues [8] and produce several pro-inflammatory cytokines, such as tumor necrosis factor alp...

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Mirabegron: a review of recent data and its prospects in the management of overactive bladder

Cited by 112 publications

References 33 publications

Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

Cost-effectiveness of mirabegron compared to tolterodine ER 4 mg for overactive bladder in Canada

Pharmacologic Management of Overactive Bladder and Urge Incontinence: A Review of New and Old Treatment Options

Mitochondrial Actions for Fat Browning and Energy Expenditure in White Adipose Tissue

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