Skip to main content
Top
Published in: Drugs 11/2013

01-07-2013 | Adis Drug Evaluation

Mirabegron: A Review of Its Use in Patients with Overactive Bladder Syndrome

Author: Mark Sanford

Published in: Drugs | Issue 11/2013

Login to get access

Abstract

Mirabegron (YM178, Myrbetriq™, Betanis®, Betmiga™) is a β3-adrenergic receptor agonist approved in several countries for the symptomatic treatment of adults with overactive bladder syndrome. In three 12-week, randomized, double-blind, placebo-controlled, multinational trials in patients with overactive bladder syndrome, oral mirabegron 25 or 50 mg once daily significantly reduced the adjusted mean number of incontinence episodes per 24 h (in patients with incontinence at baseline) and the adjusted mean number of micturition episodes per 24 h (in full trial populations) [coprimary endpoints]. Across trials, mirabegron 50 mg once daily also consistently significantly reduced urgency episodes and increased the volume of urine voided per micturition, generally in association with improved health-related quality of life (HR-QOL) and treatment satisfaction. Based on descriptive analyses from a 12-month trial, once-daily mirabegron 50 mg and tolterodine extended-release (ER) 4 mg were both efficacious in reducing urinary symptoms and improving HR-QOL. Mirabegron was generally well tolerated in the trials. Over 12 weeks, the adverse event rate with mirabegron 50 mg once daily was similar to that with placebo. During 12 months of treatment, 2.8 % of mirabegron 50 mg once daily recipients reported dry mouth compared with 8.6 % with tolterodine ER 4 mg once daily recipients. Mirabegron 50 mg once daily carries a low risk of QT interval prolongation. Thus, mirabegron is an efficacious new treatment for overactive bladder syndrome with a favourable tolerability profile.
Literature
1.
go back to reference Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMed Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMed
2.
go back to reference Wagg A, Majumdar A, Toozs-Hobson P, et al. Current and future trends in the management of overactive bladder. Int Urogynecol J. 2007;18(1):81–94.CrossRef Wagg A, Majumdar A, Toozs-Hobson P, et al. Current and future trends in the management of overactive bladder. Int Urogynecol J. 2007;18(1):81–94.CrossRef
3.
go back to reference Irwin DE, Milsom I, Hunskaar S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306–15.PubMedCrossRef Irwin DE, Milsom I, Hunskaar S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306–15.PubMedCrossRef
4.
go back to reference Milsom I, Abrams P, Cardozo L, et al. How widespread are the symptoms of overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87(9):760–6.PubMedCrossRef Milsom I, Abrams P, Cardozo L, et al. How widespread are the symptoms of overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87(9):760–6.PubMedCrossRef
5.
go back to reference Wein AJ, Chapple C. Overactive bladder in clinical practice. London: Springer; 2012.CrossRef Wein AJ, Chapple C. Overactive bladder in clinical practice. London: Springer; 2012.CrossRef
6.
go back to reference Marinkovic SP, Rovner ES, Moldwin RM, et al. The management of overactive bladder syndrome. BMJ. 2012;344(7853):38–44. Marinkovic SP, Rovner ES, Moldwin RM, et al. The management of overactive bladder syndrome. BMJ. 2012;344(7853):38–44.
7.
go back to reference Hashim H, Abrams P. Drug treatment of overactive bladder: efficacy, cost and quality-of-life considerations. Drugs. 2004;64(15):1643–56.PubMedCrossRef Hashim H, Abrams P. Drug treatment of overactive bladder: efficacy, cost and quality-of-life considerations. Drugs. 2004;64(15):1643–56.PubMedCrossRef
12.
13.
go back to reference Nitti V, Rosenberg S, Mitcheson D, et al. Urodynamic safety of the potent and selective beta3-adrenoceptor agonist, mirabegron, in males with lower urinary tract symptoms and bladder outlet obstruction [abstract no. POD-03.05]. Urology. 2012;80(3 Suppl. 1):S10. Nitti V, Rosenberg S, Mitcheson D, et al. Urodynamic safety of the potent and selective beta3-adrenoceptor agonist, mirabegron, in males with lower urinary tract symptoms and bladder outlet obstruction [abstract no. POD-03.05]. Urology. 2012;80(3 Suppl. 1):S10.
14.
go back to reference Chapple CR, Amarenco G, López Aramburu MA, et al. A proof-of-concept study: mirabegron, a new therapy for overactive bladder. BLOSSOM Investigator Group. Neurourol Urodyn. 2013. doi:10.1002/nau.22373. Chapple CR, Amarenco G, López Aramburu MA, et al. A proof-of-concept study: mirabegron, a new therapy for overactive bladder. BLOSSOM Investigator Group. Neurourol Urodyn. 2013. doi:10.​1002/​nau.​22373.
15.
16.
go back to reference Malik M, van Gelderen EM, Lee JH, et al. Proarrhythmic safety of repeat doses of mirabegron in healthy subjects: a randomized, double-blind, placebo- and active-controlled thorough QT study. Clin Pharmacol Ther. 2012;92(6):696–706.PubMedCrossRef Malik M, van Gelderen EM, Lee JH, et al. Proarrhythmic safety of repeat doses of mirabegron in healthy subjects: a randomized, double-blind, placebo- and active-controlled thorough QT study. Clin Pharmacol Ther. 2012;92(6):696–706.PubMedCrossRef
17.
go back to reference Krauwinkel W, van Dijk J, Schaddelee M, et al. Pharmacokinetic properties of mirabegron, a Β3-adrenoceptor agonist: results from two phase I, randomized, multiple-dose studies in healthy young and elderly men and women. Clin Ther. 2012;34(10):2144–60.PubMedCrossRef Krauwinkel W, van Dijk J, Schaddelee M, et al. Pharmacokinetic properties of mirabegron, a Β3-adrenoceptor agonist: results from two phase I, randomized, multiple-dose studies in healthy young and elderly men and women. Clin Ther. 2012;34(10):2144–60.PubMedCrossRef
18.
go back to reference Takusagawa S, van Lier JJ, Suzuki K, et al. Absorption, metabolism and excretion of [14C]mirabegron (YM178), a potent and selective Β3-adrenoceptor agonist, after oral administration to healthy male volunteers. Drug Metab Dispos. 2012;40(4):815–24.PubMedCrossRef Takusagawa S, van Lier JJ, Suzuki K, et al. Absorption, metabolism and excretion of [14C]mirabegron (YM178), a potent and selective Β3-adrenoceptor agonist, after oral administration to healthy male volunteers. Drug Metab Dispos. 2012;40(4):815–24.PubMedCrossRef
19.
go back to reference Eltink C, Lee J, Schaddelee M, et al. Single dose pharmacokinetics and absolute bioavailability of mirabegron, a Β3-adrenoceptor agonist for treatment of overactive bladder. Int J Clin Pharmacol Ther. 2012;50(11):838–50.PubMed Eltink C, Lee J, Schaddelee M, et al. Single dose pharmacokinetics and absolute bioavailability of mirabegron, a Β3-adrenoceptor agonist for treatment of overactive bladder. Int J Clin Pharmacol Ther. 2012;50(11):838–50.PubMed
20.
go back to reference Dickinson J, Lewand M, Sawamoto T, et al. Effect of renal or hepatic impairment on the pharmacokinetics of mirabegron. Clin Drug Invest. 2012;31(1):11–23. Dickinson J, Lewand M, Sawamoto T, et al. Effect of renal or hepatic impairment on the pharmacokinetics of mirabegron. Clin Drug Invest. 2012;31(1):11–23.
21.
go back to reference van Gelderen EM, Li Q, Meijer J, et al. An exploratory comparison of the single dose pharmacokinetics of the beta3-adrenoceptor agonist mirabegron in healthy CYP2D6 poor and extensive metabolizers [abstract no. PIII-65]. Clin Pharmacol Ther. 2009;85 Suppl.:S88. van Gelderen EM, Li Q, Meijer J, et al. An exploratory comparison of the single dose pharmacokinetics of the beta3-adrenoceptor agonist mirabegron in healthy CYP2D6 poor and extensive metabolizers [abstract no. PIII-65]. Clin Pharmacol Ther. 2009;85 Suppl.:S88.
22.
go back to reference Krauwinkel WJ, van Gelderen EM, Groen MJ. An open-label, one-sequence crossover study to evaluate the effect of multiple doses of mirabegron on the pharmacokinetics of the CYP2D6 substrate desipramine in healthy subjects [abstract no. PIII-65]. In: 111th Annual Meeting of the American Society for Clinical Pharmacology and Therapeutics; 17-20 Mar 2010; Atlanta. Krauwinkel WJ, van Gelderen EM, Groen MJ. An open-label, one-sequence crossover study to evaluate the effect of multiple doses of mirabegron on the pharmacokinetics of the CYP2D6 substrate desipramine in healthy subjects [abstract no. PIII-65]. In: 111th Annual Meeting of the American Society for Clinical Pharmacology and Therapeutics; 17-20 Mar 2010; Atlanta.
23.
go back to reference Sawamoto T, Lee J, Alak A, et al. Phase I, open-label, drug interaction study to evaluate the effect of multiple doses of ketoconazole on single dose mirabegron (YM178) oral controlled absorption system (OCAS) in healthy adult subjects [abstract no. PI-43]. Clin Pharmacol Ther. 2011;89 Suppl.:S21. Sawamoto T, Lee J, Alak A, et al. Phase I, open-label, drug interaction study to evaluate the effect of multiple doses of ketoconazole on single dose mirabegron (YM178) oral controlled absorption system (OCAS) in healthy adult subjects [abstract no. PI-43]. Clin Pharmacol Ther. 2011;89 Suppl.:S21.
24.
go back to reference Sawamoto T, Lee J, Cao Y, et al. Phase I, open-label, drug interaction study to evaluate the effect of repeat doses of rifampin on the single-dose pharmacokinetics of mirabegron (YM178) in healthy adult subjects [abstract no. PI-44]. Clin Pharmacol Ther. 2011;89 Suppl.:S21–2. Sawamoto T, Lee J, Cao Y, et al. Phase I, open-label, drug interaction study to evaluate the effect of repeat doses of rifampin on the single-dose pharmacokinetics of mirabegron (YM178) in healthy adult subjects [abstract no. PI-44]. Clin Pharmacol Ther. 2011;89 Suppl.:S21–2.
25.
go back to reference Veltkamp S, van Gelderen M, Schaddelee M, et al. Clinical study into the pharmacokinetic, pharmacodynamic and safety interaction of the novel Β3-adrenoceptor agonist mirabegron and metformin in healthy subjects [abstract no. WP107]. In: 9th Congress of the European Association for Clinical Pharmacology and Therapeutics; 12–15 Jul 2009; Edinburgh. Veltkamp S, van Gelderen M, Schaddelee M, et al. Clinical study into the pharmacokinetic, pharmacodynamic and safety interaction of the novel Β3-adrenoceptor agonist mirabegron and metformin in healthy subjects [abstract no. WP107]. In: 9th Congress of the European Association for Clinical Pharmacology and Therapeutics; 12–15 Jul 2009; Edinburgh.
26.
go back to reference Khullar V, Amarenco G, Angulo JC, et al. Efficacy and tolerability of mirabegron, a Β3-adrenoreceptor agonist, in patients with overactive bladder: results from a randomised European–Australian phase 3 trial. Eur Urol. 2013;63(2):283–95.PubMedCrossRef Khullar V, Amarenco G, Angulo JC, et al. Efficacy and tolerability of mirabegron, a Β3-adrenoreceptor agonist, in patients with overactive bladder: results from a randomised European–Australian phase 3 trial. Eur Urol. 2013;63(2):283–95.PubMedCrossRef
27.
go back to reference Nitti V, Auerbach S, Martin N, et al. Results of a randomized phase III trial of mirabegron in patients with overactive bladder. J Urol. 2013;189(4):1388–95.PubMedCrossRef Nitti V, Auerbach S, Martin N, et al. Results of a randomized phase III trial of mirabegron in patients with overactive bladder. J Urol. 2013;189(4):1388–95.PubMedCrossRef
28.
go back to reference Herschorn S, Barkin J, Castro-Diaz D, et al. A phase III, randomized, double-blind, parallel-group, placebo-controlled, multicentre study to assess the efficacy and safety of the β3 adrenoceptor agonist, mirabegron, in patients with symptoms of overactive bladder. Urology. 2013. doi:10.1016/j.urology.2013.02.077. Herschorn S, Barkin J, Castro-Diaz D, et al. A phase III, randomized, double-blind, parallel-group, placebo-controlled, multicentre study to assess the efficacy and safety of the β3 adrenoceptor agonist, mirabegron, in patients with symptoms of overactive bladder. Urology. 2013. doi:10.​1016/​j.​urology.​2013.​02.​077.
29.
go back to reference Chapple CR, Kaplan SA, Mitcheson D, et al. Randomized double-blind, active-controlled phase 3 study to assess 12-month safety and efficacy of mirabegron, a Β3-adrenoceptor agonist, in overactive bladder. Eur Urol. 2013;63(2):296–305.PubMedCrossRef Chapple CR, Kaplan SA, Mitcheson D, et al. Randomized double-blind, active-controlled phase 3 study to assess 12-month safety and efficacy of mirabegron, a Β3-adrenoceptor agonist, in overactive bladder. Eur Urol. 2013;63(2):296–305.PubMedCrossRef
30.
go back to reference Nitti VW, Khullar V, van Kerrebroeck P, et al. Mirabegron for the treatment of overactive bladder: a prespecified pooled efficacy analysis and pooled safety analysis of three randomised, double-blind, placebo-controlled, phase III studies. Int J Clin Pract. 2013;67(7):619–32.PubMedCrossRef Nitti VW, Khullar V, van Kerrebroeck P, et al. Mirabegron for the treatment of overactive bladder: a prespecified pooled efficacy analysis and pooled safety analysis of three randomised, double-blind, placebo-controlled, phase III studies. Int J Clin Pract. 2013;67(7):619–32.PubMedCrossRef
31.
go back to reference Khullar V, Cambronero J, Angulo J, et al. Age-related efficacy of the B3-adrenoceptor agonist mirabegron for the treatment of overactive bladder (OAB): pooled analysis of three prospective, randomised phase III studies in patients aged ≥65 years [abstract no. 331]. In: 42nd Annual Meeting of the International Continence Society; Oct 15–19 2012; Beijing. Khullar V, Cambronero J, Angulo J, et al. Age-related efficacy of the B3-adrenoceptor agonist mirabegron for the treatment of overactive bladder (OAB): pooled analysis of three prospective, randomised phase III studies in patients aged ≥65 years [abstract no. 331]. In: 42nd Annual Meeting of the International Continence Society; Oct 15–19 2012; Beijing.
32.
go back to reference Nitti V, Herschorn S, Khullar V, et al. Efficacy of the selective B3-adrenoceptor agonist, mirabegron, in patients with overactive bladder (OAB) who discontinued prior antimuscarinic therapy due to insufficient effect: pooled analysis of three randomised phase III studies [abstract no. 351]. In: 37th Annual Meeting of the International Urogynecological Association; Sep 4–8 2012; Brisbane. Nitti V, Herschorn S, Khullar V, et al. Efficacy of the selective B3-adrenoceptor agonist, mirabegron, in patients with overactive bladder (OAB) who discontinued prior antimuscarinic therapy due to insufficient effect: pooled analysis of three randomised phase III studies [abstract no. 351]. In: 37th Annual Meeting of the International Urogynecological Association; Sep 4–8 2012; Brisbane.
33.
go back to reference Nitti V, Herschorn S, Auerbach S, et al. The potent and selective Β3-adrenoceptor agonist mirabegron improves patient-reported outcomes in overactive bladder: results from two phase III studies [abstract no. 68]. Neurourol Urodyn. 2012;31(6):813–5. Nitti V, Herschorn S, Auerbach S, et al. The potent and selective Β3-adrenoceptor agonist mirabegron improves patient-reported outcomes in overactive bladder: results from two phase III studies [abstract no. 68]. Neurourol Urodyn. 2012;31(6):813–5.
34.
go back to reference van Kerrebroeck P, Barkin J, Castro-Diaz D, et al. Randomised, double-blind, placebo-controlled phase III study to assess the efficacy and safety of mirabegron 25 mg and 50 mg once-daily in overactive bladder (OAB) [abstract no. 359 plus poster]. In: 42nd Annual Meeting of the International Continence Society; 15–19 October 2012; Beijing, China. van Kerrebroeck P, Barkin J, Castro-Diaz D, et al. Randomised, double-blind, placebo-controlled phase III study to assess the efficacy and safety of mirabegron 25 mg and 50 mg once-daily in overactive bladder (OAB) [abstract no. 359 plus poster]. In: 42nd Annual Meeting of the International Continence Society; 15–19 October 2012; Beijing, China.
35.
go back to reference Astellas Pharma Europe, Ltd. A double-blind, randomized, parallel group, multicentre study to evaluate the efficacy and safety of mirabegron compared to solifenacin in subjects with overactive bladder (OAB) treated with antimuscarinics and dissatisfied due to lack of efficacy. 2012. http://clinicaltrials.gov/show/NCT01638000. Accessed 7 Feb 2013. Astellas Pharma Europe, Ltd. A double-blind, randomized, parallel group, multicentre study to evaluate the efficacy and safety of mirabegron compared to solifenacin in subjects with overactive bladder (OAB) treated with antimuscarinics and dissatisfied due to lack of efficacy. 2012. http://​clinicaltrials.​gov/​show/​NCT01638000. Accessed 7 Feb 2013.
Metadata
Title
Mirabegron: A Review of Its Use in Patients with Overactive Bladder Syndrome
Author
Mark Sanford
Publication date
01-07-2013
Publisher
Springer International Publishing
Published in
Drugs / Issue 11/2013
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.1007/s40265-013-0086-3

Other articles of this Issue 11/2013

Drugs 11/2013 Go to the issue