title: Comparative efficacy and safety of medical treatments for the management of overactive bladder: a systematic literature review and mixed treatment comparison.
abstract: BACKGROUND
  Overactive bladder (OAB) treatment guidelines recommend antimuscarinics as ﬁrst-line pharmacologic therapy. Mirabegron is a first-in-class β3-adrenoceptor agonist licensed for the treatment of OAB and has shown to be well tolerated and effective in the treatment of OAB symptoms.
  
  
  OBJECTIVE
  To assess the relative efficacy and tolerability of OAB medications, specifically mirabegron 50 mg versus antimuscarinics in patients with OAB.
  
  
  METHODS
  A systematic literature search was performed on published peer-reviewed articles from 2000 to 2013. This review included randomised controlled trials (RCTs) studying changes in symptoms (micturition frequency, incontinence, and urgency urinary incontinence [UUI] episodes) and incidence of the most frequently reported adverse events (dry mouth, constipation) associated with current OAB medications. The following drugs were considered in addition to mirabegron: darifenacin, tolterodine immediate release (IR) and extended release (ER), oxybutynin IR/ER, trospium, solifenacin, and fesoterodine. Bayesian mixed treatment comparisons (MTCs) were performed for efficacy (micturition, incontinence, UUI) and tolerability (dry mouth, constipation, blurred vision).
  
  
  RESULTS
  Overall, 44 RCTs involving 27,309 patients were included. The MTCs showed that mirabegron 50 mg was as efficacious as antimuscarinics in reducing the frequency of micturition incontinence and UUI episodes, with the exception of solifenacin 10 mg that was more efficacious than mirabegron 50 mg in improving micturition frequency and frequency of UUI. Mirabegron 50 mg had an incidence of dry mouth similar to placebo and significantly lower than all included antimuscarinics.
  
  
  CONCLUSIONS
  Mirabegron 50 mg had similar efficacy to most antimuscarinics and lower incidence of dry mouth, the most common adverse event reported with antimuscarinics and one of the main causes of discontinuation of treatment. Despite being a powerful tool for evidence-based health care evaluation, the Bayesian MTC method has limitations. Further head-to-head comparisons between mirabegron and antimuscarinics should be conducted to confirm our results.
authors.affiliation: Creativ-Ceutical SARL, Paris, France. Electronic address: kma@creativ-ceutical.com.
authors.forename: Khaled
authors.initials: K
authors.lastname: Maman
authors.affiliation: Creativ-Ceutical SARL, Paris, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Aballea
authors.affiliation: Astellas Pharma Europe, Chertsey, UK.
authors.forename: Jameel
authors.initials: J
authors.lastname: Nazir
authors.affiliation: Creativ-Ceutical SARL, Paris, France.
authors.forename: Katia
authors.initials: K
authors.lastname: Desroziers
authors.affiliation: Creativ-Ceutical SARL, Paris, France.
authors.forename: Mohamed-Elmoctar
authors.initials: ME
authors.lastname: Neine
authors.affiliation: Astellas Pharma Europe, Chertsey, UK; Department of Urology, Ealing Hospital, London, UK.
authors.forename: Emad
authors.initials: E
authors.lastname: Siddiqui
authors.affiliation: Astellas Pharma Europe, Chertsey, UK.
authors.forename: Isaac
authors.initials: I
authors.lastname: Odeyemi
authors.affiliation: Astellas Pharma Global Development, Leiden, The Netherlands.
authors.forename: Zalmai
authors.initials: Z
authors.lastname: Hakimi
mesh_terms: D000083:Acetanilides / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D000083:Acetanilides; D018727:Muscarinic Antagonists; D013844:Thiazoles; C520025:mirabegron
keywords: Antimuscarinics; Mirabegron; Mixed treatment comparison; Overactive bladder; Systematic reviews