Video‐urodynamic effects of mirabegron, a β₃‐adrenoceptor agonist, in patients with low‐compliance bladder

Abstract

Abbreviations & Acronyms AA = anticholinergic agents BC = bladder compliance BoNT-A = botulinum toxin A CC = cystometric capacity CE = cleansing enema CIC = clean intermittent catheterization DO = detrusor overactivity Dx/HA = dextranomer hyaluronic acid copolymer injection for vesicoureteral reflux FDV = first desire to void JUH = Jikei University Hospital LUTD = lower urinary tract dysfunction OAB = overactive bladder P abd = abdominal pressure (cmH 2 O) P det = detrusor pressure P ves = intravesical pressure (cmH 2 O) UTH = The University of Tokyo Hospital UTI = urinary tract infection Vol. = infusion volume (mL) V-UDS = video-urodynamic study VUR = vesicoureteral reflux Objectives: To investigate video-urodynamic effects of mirabegron, a b 3 -adrenoceptor agonist, on low-compliance bladder. Methods: We retrospectively reviewed nine patients (three men, six women, age 17-68 years) who had been diagnosed with lower urinary tract dysfunction with lowcompliance bladder, and who underwent video-urodynamic study before and during administration of mirabegron 50 mg once daily. Urodynamic parameters were compared before and after treatment. Results: Mirabegron treatment significantly increased first desire to void and cystometric capacity with an average increment of 80 mL (P = 0.027) and 123 mL (P = 0.005), respectively. Bladder compliance also significantly increased (mean value 8.1 mL/cmH 2 O before, 18.2 mL/cmH 2 O after, P = 0.024). In the six patients who had been taking anticholinergic agents at baseline video-urodynamic study and then switched to mirabegron, mean cystometric capacity and bladder compliance were also increased significantly from 208.3 to 346.8 mL (P = 0.015) and from 7.2 to 17.5 mL/cmH 2 O (P = 0.047), respectively. Vesicoureteral reflux grade was improved in three of the four patients who had shown vesicoureteral reflux on cystography before treatment. Conclusions: Mirabegron improves cystometric capacity and bladder compliance, and it lowers vesicoureteral reflux grade in patients with low-compliance bladder. Thus, mirabegron might represent a good alternative drug for low-compliance bladder refractory to anticholinergic treatment.

Comparisons of the Clinical Outcomes and Urodynamic Effects of Mirabegron versus Tolterodine Treatment for Female Overactive Bladder Syndrome: A Subgroup Analysis of a Controlled, Randomised, Prospective Study

“…We determined that there was significant improvement in the volume at strong desire to void in both the mirabegron and tolterodine groups (Table ), which is similar to previous research . Increases in the cystometric capacity following mirabegron have been reported in women with OAB; in addition, similar findings in low compliance patients (three men and six women) and spinal cord injury patients, had been observed. The urodynamic findings of tolterodine are similar to previous reports …”

Long‐term persistence with mirabegron in a real‐world clinical setting

“…13 Other factors associated with better persistence with mirabegron were female patients, older aged patients or polypharmacy according to the previous studies. [21][22][23] Thus, better efficacy of combination therapy could result in a better persistence rate with mirabegron. Furthermore, the greater efficacy of combination therapy with mirabegron and antimuscarinics for OAB patients has already been reported.…”

Combinational effects of muscarinic receptor inhibition and β3‐adrenoceptor stimulation on neurogenic bladder dysfunction in rats with spinal cord injury

“…Mirabegron is considered a second line therapy to anticholinergics; however, there are still no recommendations for the combination therapy of anticholinergics and β3‐adrenoceptor agonists in any clinical guidelines . Recent clinical studies indicated that mirabegron for patients with neurogenic bladder dramatically improved bladder storage function and bladder deformity; however, there are few research studies to prove that mirabegron or the combination treatment are effective for neurogenic bladder dysfunction. In the present animals study, only the combination therapy of oxybutynin and mirabegron improved bladder compliance, ICI, voided volume, bladder capacity, and integral of NVCs compared to the vehicle therapy.…”