Neurological safety and efficacy of darifenacin and mirabegron for the treatment of overactive bladder in patients with history of cerebrovascular accident: A prospective study

Abstract

Objectives: To evaluate the neurological safety and clinical efficacy of darifenacin and mirabegron in patients with a history of cerebrovascular accident (CVA) who had overactive bladder (OAB) symptoms.Methods: This prospective randomized study, approved by the institute's ethics committee, was carried out at a tertiary care center from December 2018 to June 2020. Treatment naïve adult patients with a past history of CVA with stable neurological status for atleast past 3 months with symptoms of OAB for 3 or more months were included. Eligible patients received either darifenacin or mirabegron for a period of 3 months and various parameters on the 3-day International Consultation on Incontinence Questionnaire (ICIQ) bladder diary, the Montreal Cognitive Assessment-Basic score (MoCA-B), and the adverse events at 3 months posttreatment were compared to that at the baseline.Results: A total of 60 patients were included, 30 in each arm. After 3 months of treatment with darifenacin or mirabegron, the majority of the ICIQ bladder diary parameters improved and there was no deterioration in the cognitive function as noted on the MoCA-B score in either of the arms. On intergroup comparison, the mean change in bladder diary parameters and the MoCA-B scores was similar between the two groups. Conclusion: Darifenacin and mirabegron, in the short term, do not adversely affect the cognitive function in patients with a history of CVA with OAB symptoms. Both are safe and effective treatment options in patients with OAB post-CVA.

Efficacy of overactive neurogenic bladder treatment: A systematic review of randomized controlled trials

“…In patients who had ischemic stroke, mirabegron and darifenacin showed similar improvement of bladder diary parameter without deterioration of cognitive function (32). Both combination of trospium chloride with oxybutynin, and solifenacin with oxybutynin improved subjective and urodynamic urinary parameters, though side effects were higher in patients taking oxybutyinin plus solifenacin (33).…”

“…Cardiovascular parameters were not significantly affected by mirabegron treatment although patients at risk for cardiovascular disease were excluded from most trials. Mirabegron was compared to darifenacin in the treatment of OAB in patients with a history of cerebrovascular accident (32). No differences in bladder diary parameters were observed between groups.…”

Detrusor relaxing agents for neurogenic detrusor overactivity: a systematic review, meta‐analysis and network meta‐analysis

“…As shown in Fig. 1, 23 RCTs were included with a total of 1697 patients [14–36]. In all, 16 studies investigated the efficacy and safety of antimuscarinics.…”

“…Both agents showed improvement after 3 months; however, no statistical difference was noted between the two cohorts. An RCT performed by Vasudeva et al [17] reported that both bladder diary parameters, Montreal Cognitive Assessment-Basic scores, and AEs were similar between darifenacin and mirabegron. We failed to perform a direct comparison of meta-analysis because no data on mean and SD were available.…”

Role of Urological Botulinum Toxin-A Injection for Overactive Bladder and Voiding Dysfunction in Patients with Parkinson’s Disease or Post-Stroke

“…First-line behavioral therapy may increase independent voiding behavior to control LUTS [ 64 , 65 ]. Second-line therapies of antimuscarinics and mirabegron also may improve OAB symptoms and not affect cognitive function during short-term observation [ 64 , 66 ]. However, post-stroke incontinence may last for a long time and not recover spontaneously.…”