Mirabegron effective for women over age 80 with overactive bladder

Mirabegron monotherapy is a safe and effective treatment for women over age 80 with overactive bladder (OAB) and prior anticholinergic therapy, according to a retrospective analysis.¹

“Mirabegron is an effective and safe therapy in very older (>80 years) women with OAB. We recommend mirabegron monotherapy as an alternative medical treatment choice for the management of OAB. Prospective randomized trials with larger samples are required to achieve a better understanding,” the authors wrote in their study conclusion.

The results showed that there was a statistically significant improvement in symptom scores aftermirabegron monotherapy, as measured by the Overactive Bladder-Validated Eight-Question (OAB-V8) form. The median scores before and after treatment were 19 (range, 10-28) and 10 (range, 7-14), respectively (P = .023).

Further, the investigators’ statistical models specifically showed that urgency (6 vs 3), frequency (12 vs 7), and nocturia (2 vs 1) scores were all significantly lower following mirabegron therapy (P <.05 for all comparisons).

For this retrospective analysis, investigators led by Cihat Özcan, MD, department of urology, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey, included 42 women aged >80 years with OAB.

Patients had to have uncomplicated OAB symptoms; presence of complaints for 3 months or longer; prior use of ≥1 anticholinergic drug as monotherapy or in a combination regimen that was subsequently discontinued by one of the non-urology departments at the investigators’ hospital; and completion of an evaluation using the OAB-V8 form prior to and after treatment.

All patients had received single-agent mirabegron at 50 mg per day for 12 weeks or longer following discontinuation of anticholinergic treatment.

The median patient age was 86 years (range, 80-93). Patients had a median of 4 (range, 2-6) comorbid conditions and were taking a median of 6 (range, 3-9) concomitant medications. The median symptom score (OAB-V8 form) at baseline was 19 (range, 10-28). The median baseline voiding volume was 127 mL (range, 100-148), and the median post-void residual volume was 16 mL (range, 6-58). The maximum flow rate was 12 mL/second (range, 9-16).

No significant difference was observed between systolic and diastolic blood pressure and heart rate before and after treatment with mirabegron. The median patient heart rate at baseline was 64 beats/minute (range, 57-73) and following treatment was 66 beats/minute (range, 53-82; P = 0.48). The median systolic and diastolic blood pressure was 129 mmHg (range, 95-145) vs 127 (range 96-149; P = 0.32) and 82 mmHg (range, 65-104) vs 85 (range, 68-105; P = 0.11), respectively.

Adverse events reported were dry mouth (2 patients), headache (1 patient), constipation (2 patients), dizziness (1 patient), dyspepsia (2 patients), nasal congestion (1 patient), and nausea (1 patient).

Regarding limitations of their study, the authors noted that the study was retrospective, the study population size was small, and the study only assessed short-term outcomes (12-weeks period).

“Mirabegron is an effective and safe therapy in very older (>80 years) women with OAB. We recommend mirabegron monotherapy as an alternative medical treatment choice for the management of OAB. Prospective randomized trials with larger samples are required to achieve a better understanding,” Özcan et al wrote in their study conclusion.

Reference

1. Özcan C, Sancı A, Beyatlı M, et al. The Efficiency and Safety of Mirabegron Monotherapy for the Treatment of Urge Incontinence in Women Aged >80 Years [published online January 12, 2023]. Cureus. doi:10.7759/cureus.33685