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

Abstract

Aims: We aimed to investigate the effectiveness and safety of mirabegron for adult and child patients with neurogenic lower urinary tract dysfunction (NLUTD). Methods: A comprehensive search for articles about mirabegron treatment of NLUTD patients was conducted in PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov databases. Retrospective studies and randomized-controlled studies were included if they met the inclusion criteria and were evaluated by different quality evaluation methods according to study types. Mean difference (MD) and 95% confidence intervals (CIs) were calculated using fixed-effects models or random models depending on heterogeneity. Clinical and urodynamic parameters were pooled to evaluate the efficacy, and safety was measured by adverse events rate. Results: A total of 10 studies with 314 participants were finally included. Four retrospective and six prospective studies containing two randomized-control trials met the inclusion criteria with moderate and high evidence levels. Compared to the baseline date, the pooled results suggested that patients who underwent mirabegron treatment presented less urinary frequency (MD = −0.70; 95% CI: −1.08 to −0.32; p < 0.01) and less incontinence (MD = −1.62; 95% CI: −2.20 to −1.03; p < 0.01), showed conspicuous improvements in adult and child patients' urodynamic parameters, while the incidence of adverse events (10.0% on average, 0%-31.25%) also demonstrated the safety of mirabegron. Conclusion: Mirabegron can significantly improve urodynamic parameters and quality of life in adult and child patients with NLUTD, and increase patient compliance with a smaller complication rate.

Safety and efficacy of beta-3 adrenergic agonists in treating neurogenic lower urinary tract dysfunction: A systematic review and meta-analysis

“…In 2022, another systematic review reported that mirabegron could improve urodynamic indicators and QOL with a low complication rate in patients with NLUTD. This systematic review included RCTs and non-randomized studies including prospective and retrospective cohorts [ 40 ]. Therefore, we advise caution with the interpretation of these findings, considering the inherent major risk of bias of non-randomized studies.…”

“…We rated CoE according to the GRADE approach, which is a valuable guidance tool for decision making. Additionally, this review focused on patients' important outcomes such as urinary symptom scores, QOL, and major adverse events unlike previous systematic reviews that reported largely on urodynamic parameters with less emphasis on patient-important outcomes and none of them utilized the GRADE approach [ 37 39 40 ]. We also performed a comprehensive search using multiple databases, trial registries, and other grey literature sources without language restrictions.…”

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

“…Although mirabegron has been used in patients with NDO, the clinical evidence is still limited. In contrast, a meta‐analysis including both RCT and non‐RCTs revealed that mirabegron significantly improved urinary frequency and incontinence, as well as urodynamic parameters [40]. The promising result needs to be confirmed by high‐quality RCTs with a large sample size and a long follow‐up period.…”

The effectiveness and safety of oral medications, onabotulinumtoxinA (three doses) and transcutaneous tibial nerve stimulation as non or minimally invasive treatment for the management of neurogenic detrusor overactivity in adults: a systematic review and network meta-analysis

“…Pharmacotherapy is the conventional and conservative method of treating NDO, with convenience and low-cost advantages. Several systematic reviews by Buser 40 , Shim 15 , and Yuanzhuo 41 have demonstrated the effectiveness of drug therapy. However, they also mentioned the side effects associated with medications, which often make it difficult for patients to adhere to long-term treatment.…”