Antimuscarinics or β3 Adrenoreceptor Agonists: Which Should Be the First Step?

Antimuscarinics are historically considered the cornerstone for pharmacological treatment of overactive bladder syndrome (OAB). The more recent introduction of β3 adrenoreceptor agonists has increased the range of therapeutic possibilities, but it is still not possible to determine a priori which drug class should be used first. Considering the comparable effectiveness in terms of symptom improvement, the choice should take into account the different tolerability profile of these drugs according to the patient's clinical features (age, neurologic disease and comorbidities, and risk factors for adverse events). In the absence of specific characteristics that guide the choice towards one of these drug classes, shared decision-making with the patient that takes into account their personal values, preferences, and expectations should be undertaken. PATIENT SUMMARY: We provide recommendations on choice of the first drug type to use in treating overactive bladder. Two drug classes with similar effectiveness but different side effects are available. The decision on which medication to use first should take into account the patient's characteristics and their personal values, preferences, and expectations.