I’d like to discuss the management of several common voiding dysfunctions, starting with overactive bladder. What is the current state of therapy using oral medications, and how can we expect our oral therapy options to change in the future?
The current first-line therapies are various antimuscarinic drugs and the beta-3 receptor agonist mirabegron (Myrbetriq). There may be changes in the proportion of people treated first with antimuscarinic drugs or the beta-3 agonist, but for the next 5 years at least, these two drug classes will be first-line pharmacologic therapy. There are possibilities to treat those who do not respond to these two types of treatment with botulinum toxin (Botox).
If we look at what’s in the pipeline, there are very few new drug principles. There are a couple of new antimuscarinic drugs in development, but they don’t appear to have any specific properties that would make them better than the ones we have. Since we have such a low number of established and accepted drugs, I think we have to use combinations. One of the combinations in the pipeline is the antimuscarinic solifenacin succinate (VESIcare) plus mirabegron, which is currently in phase III trials. We will likely see that drug combination on the market within the next few years.