Exploring the therapeutic potential of Beta-3 adrenergic agonists in overactive bladder: A comparative analysis of monotherapy versus combination therapy strategies.

OBJECTIVE

Aim: to compare effects and side-effect profiles between mirabegron monotherapy and 2 combination treatments including mirabegron in patients with OAB.

PATIENTS AND

METHODS

Materials and

Methods

Study is nonrandomized, prospective, and observational; conducted in 22 centers, 400 patients with OAB symptoms. Patients administered 50 mg monotherapy of mirabegron for 8 weeks. Responders received monotherapy (Group 0, n=109) and non-responders allocated to double therapy with mirabegron plus Solifenacin 5mg (Group 1, n=145) or mirabegron plus Flavoxate/Uripas (Group 2, n=146) for an additional eight weeks. Providing bladder volume, postvoid residual and BWT served as primary end points.

RESULTS

Results

Prevalence of urgency, frequency, and nocturia was high in cohort (92.8%, 88.5%, and 76.5%), but that of UUI35 was low at 9%. This indicates that patients are clearly of OAB-dry phenotype. Mixed storage-voiding symptom was most frequent among 53.8%. An unusual baseline comparison population along to chew, - 200% male and severe symptom' GROUPS 2 BWT a benefit of mirabegron\+\-Solifenacin); one could get; other couldn't (-36ml vs. -31ml). End-point analysis did not allow exclusion of therapeutic equipoise of REGULAR vs. DROP for final PVR (between-group difference: -1.48 mL, p = 0.065).

CONCLUSION

Conclusions

Beta-3 agonist as monotherapy is a potent, multimodality first-line therapy with strong influence of severe disease. Each of combinatory treatments show characteristic effect on phenotype-specific increase in bladder capacity. Mirabegron flaoxate could be considered for detrusor hypertrophy and combination of mirabegron Solifenacin would stimulate voiding facilitate. These proof of concept data justify PPTP based on objective biomarkers such as BWT and PVR to select combination therapy in what is another small step in our journey towards precision medicine for OAB.