title: Emerging drugs for overactive bladder.
abstract: BACKGROUND
  Overactive bladder (OAB) is a common problem which can have disastrous effects on the quality of life of the sufferer. There are established treatments for the problem but they have significant adverse effects. Better drugs and new treatment modalities are necessary to deal with OAB.
  
  
  METHODS
  Antimuscarinics, mirabegron and intravesical injection of botulinum toxin A are established treatments for OAB. Sacral neuromodulation is more invasive but has been successful in treating OAB. Phase II and III trials are in progress for newer β3-agonists and various combinations of antimuscarinics, β3-agonists and antidiuretics. Targeted secretion inhibitors (TSI) can increase efficacy and reduce adverse effects. Liposome integrated botulinum toxin A has an advantage of effective administration by intravesical instillation. Both medicines are in Phase II trials. Many other drugs which have promising results are discussed.
  
  
  CONCLUSIONS
  Newer antimuscarinics have better tolerability. Long-term data for mirabegron has shown that it is more effective in severe OAB. Combination drugs may prove to be more effective with less adverse effects. Emerging treatments with TSI, lipotoxin and gene therapy appear promising.
authors.affiliation: a 1 Clinical Research Fellow, St Mary's Hospital, Imperial College, Urogynaecology Department , London, UK +44 0 79 83 41 40 71 ; roopalikarmarkar@gmail.com.
authors.forename: Roopali
authors.initials: R
authors.lastname: Karmarkar
authors.affiliation: b 2 St Mary's Hospital, Imperial College, Urogynaecology Department , London, UK.
authors.forename: Vik
authors.initials: V
authors.lastname: Khullar
mesh_terms: D000083:Acetanilides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D058667:Adrenergic beta-3 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000818:Animals; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use; D015195:Drug Design; D004359:Drug Therapy, Combination; D006801:Humans; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011788:Quality of Life; D013844:Thiazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000083:Acetanilides; D058667:Adrenergic beta-3 Receptor Agonists; D018727:Muscarinic Antagonists; D013844:Thiazoles; D019274:Botulinum Toxins, Type A; C520025:mirabegron
keywords: antimuscarinic; botulinum toxin A; detrusor overactivity; incontinence; overactive bladder; β3-agonist