title: Third-line treatment for overactive bladder: should mirabegron be tried before intravesical botulinum toxin A therapy?
abstract: OBJECTIVE
  Mirabegron is a new beta 3 agonist for the treatment of overactive bladder (OAB). Although there are extensive data from randomised controlled trials, there is little real world evidence about its effectiveness and side effects. We conducted a prospective cohort study to evaluate the effectiveness of mirabegron as third-line treatment in patients with refractory OAB who did not benefit from antimuscarinic therapy and bladder drill.
  
  
  METHODS
  The study was a prospective consecutive cohort of 67 women treated with mirabegron 50 mg. All the patients had symptoms of urgency with or without urgency incontinence and had failed to improve with bladder drill and at least one antimuscarinic medication. The outcomes were assessed after 6 weeks using the International Consultation of Incontinence Modular Questionnaire Short Form (ICIQ-SF), Patient Global Impression of Improvement (PGI-I) scale and Kings Health Questionnaire (KHQ).
  
  
  RESULTS
  The mean number of previous antimuscarinics was 2.81 (range 1-6). Forty out of 67 patients (60 %) described an improvement in their OAB. Responders demonstrated a significant improvement in 5 out of 10 domains of the KHQ. Similarly, the ICI-Q score improved from a mean of 12.7 (±5.3) to 9.2 (±5.3; p ≤ 0.008). Seven women (10 %) stopped mirabegron because of side effects.
  
  
  CONCLUSIONS
  This post-marketing surveillance study confirms that mirabegron improves clinical and quality of life outcomes in patients with OAB. The rate of side effects was low. This study supports mirabegron use as a third-line treatment for overactive bladder.
authors.affiliation: Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK, aswini@doctors.net.uk.
authors.forename: Aswini
authors.initials: A
authors.lastname: Balachandran
authors.forename: Natasha
authors.initials: N
authors.lastname: Curtiss
authors.forename: Maya
authors.initials: M
authors.lastname: Basu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Duckett
mesh_terms: D000083:Acetanilides / Q000009:adverse effects / Q000627:therapeutic use*; D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use; D000283:Administration, Intravesical; D058667:Adrenergic beta-3 Receptor Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D011358:Product Surveillance, Postmarketing; D011446:Prospective Studies; D019233:Retreatment; D012720:Severity of Illness Index; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000628:therapy
chemical_list: D000083:Acetanilides; D065087:Acetylcholine Release Inhibitors; D058667:Adrenergic beta-3 Receptor Agonists; D013844:Thiazoles; D019274:Botulinum Toxins, Type A; C520025:mirabegron