An updated meta-analysis of head-to-head trials comparing the efficacy, safety, and adherence of mirabegron and vibegron in overactive bladder.

BACKGROUND

This updated meta-analysis aimed to compare the efficacy, safety, and treatment adherence of mirabegron and vibegron in patients with overactive bladder with head-to-head trials.

METHODS

A systematic literature search was conducted in PubMed, Embase, ClinicalTrials.gov, and the Cochrane Library from January 1, 2016 to July 6, 2025. Comparative studies evaluating mirabegron versus vibegron were included. Study selection followed the PICOS framework, and quality assessment was performed using the Cochrane Handbook for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale for non-RCTs. Outcomes included changes in voiding diary parameters, urodynamic measures, overactive bladder symptom scores, adverse events, and treatment adherence. Statistical analyses were conducted using Review Manager 5.3.

RESULTS

Six studies met the inclusion criteria. Vibegron was associated with a greater reduction in daily urgency episodes (standardized mean difference [SMD] = 0.37, P = .0006) and urinary urge incontinence (UUI) episodes (SMD = 0.33, P = .006) compared to mirabegron. However, no significant differences were found in other efficacy parameters or overall safety profiles. Vibegron demonstrated better adherence, with a higher continuation rate and lower discontinuation rate.

CONCLUSION

Recent data indicated that vibegron demonstrated superior efficacy in reducing urgency and UUI episodes while maintaining a safety profile comparable to mirabegron. Furthermore, vibegron is associated with improved treatment adherence. However, additional RCTs are necessary to confirm these findings.