Insights into the Management of Overactive Bladder: What Difference Can Mirabegron Make?/Asiri Aktif Mesane Tedavisinin Degisen Yuzu: Mirabegron'u Farkli Kilan Ozellikler Ne Olabilir?

• Published in: Journal of urological surgery Vol. 6; no. 2; p. 85
• Main Authors: Acar, Omer, Erton, Mustafa Levent, Tarcan, Tufan
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01-06-2019
• Subjects: Clinical trials; Drug therapy; Elderly; Elderly patients; Hypertension; Mirabegron; Patient compliance; Pharmaceutical industry; Solifenacin; Urinary incontinence; United States
• ISSN: 2148-9580; 2148-9580
• DOI: 10.4274/jus.galenos.2019.2533

Oral pharmacotherapy constitutes second-line treatment for overactive bladder (OAB) after lifestyle modifications, bladder retraining, and pelvic floor muscle exercises. Antimuscarinics have an established role in the treatment of OAB. However, antimuscarinics are known to have low persistence rates in clinical practice. Mirabegron is an oral [beta]3-adrenoreceptor agonist which has emerged as an alternative to antimuscarinics for managing OAB. Overall, mirabegron has similar clinical efficacy to antimuscarinics and is superior to placebo. Mirabegron has been generally well tolerated in both interventional and non-interventional studies. Persistence has been shown to be higher with mirabegron than with antimuscarinics in real-world studies. Increased blood pressure is associated with mirabegron and therefore its use is contraindicated in patients with severe uncontrolled hypertension. However, a low rate of treatment cessation due to cardiovascular issues has been noted in clinical trials. Mirabegron's utility in the elderly patient population has been well supported with promising efficacy and safety outcomes. New data from a prospective placebo-controlled randomized trial in older OAB patients is expected to be published soon. Mirabegron does not interfere with detrusor contractions during the emptying phase of the micturition cycle and hence lacks any significant effect on post-void residual volume. Mirabegron can be combined with antimuscarinics to synergize clinical effectiveness. Overall, mirabegron represents a well-tolerated and effective medical treatment option for OAB. Mirabegron could be used as an alternative to antimuscarinics, especially in patients who do not improve with antimuscarinics and/or experience bothersome side effects for whom anticholinergic load may be a relevant consideration. Keywords: Overactive bladder, Pharmacotherapy, Antimuscarinic, Beta3 agonist, Side effects Asiri aktif mesane (AAM) siklikla karsilasilan ve hayat kalitesini olumsuz yonde etkileyen bir saglik sorunudur. AAM'nin tedavisinde ilk basamagi yasam tarzi modifikasyonlari, iseme aliskanliklarinin duzenlenmesi ve pelvik taban egzersizleri olusturmaktadir. Antimuskariniklerin temelini temsil ettigi oral farmakoterapi, tedavide ikinci basamakta yer almaktadir. Ancak, antimuskariniklere bagli yan etkiler ve tolerans sorunlari, ozellikle uzun vadede, tedaviye uyum oranini azaltmaktadir. Bir oral p3-adrenerjik reseptor agonisti olan Mirabegron, AAM'nin medikal tedavisinde antimuskariniklere alternatif olarak gelistirilmistir. Klinik etkinliginin plasebo'dan daha ustun oldugu kanitlanmistir. Genel olarak, antimuskarinikler ile benzer klinik etkinlige sahiptir. Klinik calismalarda genellikle iyi tolere edildigi tespit edilmistir. Mirabegron kan basincini yukseltebilir ve dolayisiyla agir, kontrolsuz hipertansiyon varliginda kullanimi kontrendikedir. Kardiyovaskuler yan etkilere bagli olarak tedaviyi sonlandirma orani oldukca dusuktur. Geriyatrik hasta grubunda da etkin ve guvenilir bir sekilde kullanilabilecegini destekleyen calismalar yayinlanmistir. Henuz devam etmekte olan prospektif plasebo-kontrollu randomize calismasinin sonuclari, Mirabegron'un AAM tedavisindeki yerini daha da aydinlatacaktir. Mirabegron'un bosaltim fazindaki detrusor kontraksiyonlarini engellemedigi hayvan calismalarinda gosterilmistir. Dolayisiyla, post-miksiyonel reziduel idrar miktarini anlamli duzeyde yukseltmemektedir. Klinik etkinligi sinerjistik olarak arttirmak adina mirabegron ve antimuskarinikler kombine olarak kullanilabilir. Sonuc olarak mirabegron, AAM'nin medikal tedavisinde tercih edilebilecek, etkin, guvenilir ve iyi tolere edilen bir oral farmakoterapi secenegidir. Ozellikle antimuskarinik tedaviye ragmen yakinmalari devam eden, antikolinerjik yan etkilerden muzdarip ve/veya total antikolinerjik ilac yukunun fazla oldugu hastalarda antimuskarinik ilaclarin yerine tercih edilebilir. Anahtar Kelimeler: Asiri aktif mesane, Farmakoterapi, Antimuskarinik, Beta3 agonist, Yan etki