title: Comparative Efficacy and Tolerability of Antimuscarinic Agents and the Selective β3-Adrenoceptor Agonist, Mirabegron, for the Treatment of Overactive Bladder: Which is More Preferable as an Initial Treatment?
abstract: OBJECTIVE
  The objective of the present study was to evaluate comparative efficacy and tolerability of antimuscarinics and mirabegron as primary and salvage therapy in patients with overactive bladder (OAB).
  
  
  METHODS
  Patients ≥50 years with OAB symptoms were enrolled. Patients were initially treated with antimuscrinics or mirabegron for 8 weeks. When patients were refractory or intolerant to an initial treatment, drugs were switched to the other. The initial and second-line efficacy was assessed at baseline, 4 and 8 weeks after the treatment having the following parameters of the International Prostatic Symptom Score (IPSS), quality of life (QOL) index, Overactive Bladder Symptom Score (OABSS) and post-void residual (PVR) urine volume. Dry mouth and constipation were evaluated using dry mouth scale and constipation assessment scale, respectively.
  
  
  RESULTS
  A total of 117 patients were enrolled. As an initial treatment, 60 patients were given antimuscarinics and 57 patients received mirabegron. Similar initial treatment efficacy was observed between the two drugs in the whole patients. However, mirabegron was more efficacious to men with OAB unresponsive to prior α1-blocker. Dry mouth and constipation were less burdensome in patients treated with mirabegron. Such differences in efficacy and tolerability were associated with significantly greater persistence of mirabegron. As a second-line setting, both drugs appear to be equally effective at least to relieve urgency symptoms remaining after an initial therapy.
  
  
  CONCLUSIONS
  The present study suggests that mirabegron seems to have priority as an initial therapy with a distinct efficacy/tolerability balance. Mirabegron also represents a reasonable alternative to antimuscarinics for patients who had insufficient efficacy and poor tolerability.
authors.affiliation: Department of Urology, Utsunomiya Memorial Hospital, Utsunomiya, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Urology, Nasu Red Cross Hospital, Ohtawara, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Nukui
authors.affiliation: Department of Urology, Dokkyo Medical University, Mibu, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Kamai
mesh_terms: D000083:Acetanilides / Q000627:therapeutic use*; D058667:Adrenergic beta-3 Receptor Agonists / Q000627:therapeutic use*; D000368:Aged; D000704:Analysis of Variance; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life; D013844:Thiazoles / Q000627:therapeutic use*; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*; D064804:Urological Agents / Q000627:therapeutic use*
chemical_list: D000083:Acetanilides; D058667:Adrenergic beta-3 Receptor Agonists; D018727:Muscarinic Antagonists; D013844:Thiazoles; D064804:Urological Agents; C520025:mirabegron
keywords: antimuscarinics; efficacy; mirabegron; overactive bladder; tolerability