English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

© Translational Andrology and Urology. All rights reserved. Overactive bladder (OAB) is a complex syndrome with a high prevalence. It affects all ages, but is increasingly prevalent as age increases (1-4). Many treatments have been proposed for the management of the condition, including physical therapies (magnetic stimulation, electrical stimulation, posterior percutaneous tibial nerve stimulation) (5) and intravesical injections with botulinum toxin A. Drug treatment with antimuscarinic and beta 3 agonist, however, is the therapy of choice for most patients. Antimuscarinic drugs are an early treatment option for adults with OAB, while mirabegron has only been available since 20135 and three different systematic reviews demonstrated significant efficacy and safety in treating symptoms of OAB (6-8), thus expanding therapeutic possibilities for the treatment of syndrome. In this issue of European Urology, Chapple et al. (9) summarize efficacy and safety reporting of mirabegron treatment for OAB syndrome. They pooled data from global double-blind, 12-week studies in patients with OAB receiving as monotherapy mirabegron, antimuscarinic (solifenacin or tolterodine) or placebo. Analyses evaluated safety, tolerability, and efficacy of each treatment and assessed differences in baseline characteristics and among subgroups: age <65 versus >65 year, age <75 versus >75 year, and men versus women. Authors found that drugrelated adverse events are more frequent with antimuscarinics (AM) followed by mirabegron (MIRA) and then placebo. The incidence of dry mouth for AM group is higher (8.7%) than that for MIRA (2.7%) or placebo (2.4%) group. Overall frequency of treatment-emergent adverse events (TEAEs) is 5–10% higher for older versus younger patients and 6–7% higher for women versus men. TEAEs increased with age more in the AM than in the MIRA population and in particular constipation was seen with high frequency in AM group. Hypertension frequency is similar in treatment groups and urinary retention is <1% in all treatment groups, age groups and in both sexes. At the end of treatment mirabegron (25 and 50 mg) and antimuscarinics (solifenacin 5 mg and tolterodine 4 mg) were associated with a higher improvement versus placebo in the mean number of incontinence episodes/24 h, urgency episodes/24 h, volume voided/micturition and nocturia episodes. The significance of changes from baseline was, in general, greater in older patients, women and those who had received prior OAB medication. How to interpret this data? The greatest incidence of dry mouth and the highest rate of constipation in older patients in antimuscarinic group does not surprise us, due to anticholinergic effects of antimuscarinics. Vazquez Roque et al. (10) showed that aging process of the enteric nervous system, pelvic floor dysfunction like a decreased Editorial Commentary

translational andrology and urology

Comment on: Safety and efficacy of mirabegron: analysis of a large integrated clinical trial database of patients with overactive bladder receiving mirabegron, antimuscarinics, or placebo