Oral pharmacotherapy for overactive bladder in older patients: mirabegron as a potential alternative to antimuscarinics

Abstract

Mirabegron has a more favorable tolerability profile than antimuscarinics amongst older patients and may provide an improved benefit-to-risk ratio and therefore be considered as an alternative to antimuscarinics for older patients.

Safety and effectiveness of mirabegron in patients with overactive bladder aged ≥75 years: Analysis of a Japanese post‐marketing study

“…Mirabegron, a β3-adrenoceptor agonist with bladder-specific action, has been considered a favorable treatment option for OAB, particularly among the aging population. [23][24][25]28,36 Here we report the first large-scale post-marketing evaluation on safety and effectiveness of mirabegron in Japanese patients with OAB aged ≥75 years.…”

“…Mirabegron is a first‐in‐class, β3‐adrenoceptor agonist that enhances the relaxation of detrusor smooth muscle and increases storage capacity without affecting voiding ability . Notably, mirabegron has a favorable tolerability profile and an improved benefit‐to‐risk ratio compared with antimuscarinics in patients with OAB aged ≥65 years …”

“…[23][24][25][26] Notably, mirabegron has a favorable tolerability profile and an improved benefit-to-risk ratio compared with antimuscarinics in patients with OAB aged ≥65 years. 27,28 Recently, we conducted a 12-week post-marketing study on Japanese patients with OAB initiating treatment with mirabegron in a routine clinical setting. 29 Interestingly, the proportion of patients aged ≥65 years was >80%, which was higher than that reported in Japanese clinical studies, 30,31 and nearly half of the patients (48.8%) were ≥75 years old.…”

The actions of isoprenaline and mirabegron in the isolated whole rat and guinea pig bladder

“…Data has been put forward to suggest that mirabegron has a low incidence of central nervous system effects at therapeutic doses (Wagg et al, 2016). Therefore attention is focussing on mechanisms located in the periphery, such as the afferent nerve fibers (Aizawa et al, 2012) and the motor-sensory system (Gillespie et al, 2012).…”

Effect of mirabegron on cognitive function in elderly patients with overactive bladder: MoCA results from a phase 4 randomized, placebo-controlled study (PILLAR)

“…Mirabegron is a β 3 -adrenoreceptor agonist that represents an alternative OAB treatment to antimuscarinics, and potentially has a more favorable benefit-to-risk ratio in older patient populations [20][21][22][23]. The PILLAR study compared flexibly-dosed mirabegron versus placebo in community-dwelling elderly patients ≥65 years with OAB and incontinence [24].…”