PMID- 26828974
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20181202
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 32
IP  - 4
DP  - 2016
TI  - Oral pharmacotherapy for overactive bladder in older patients: mirabegron as a 
      potential alternative to antimuscarinics.
PG  - 621-38
LID - 10.1185/03007995.2016.1149806 [doi]
AB  - OBJECTIVE: Overactive bladder (OAB) is a particular challenge to treat in older 
      adults with co-morbid conditions taking multiple medications. Antimuscarinics 
      (e.g., solifenacin, fesoterodine) and beta3-adrenergic receptor agonists 
      (mirabegron) are similarly efficacious; however, antimuscarinics may be 
      associated with side effects that result in poor persistence and contribute to 
      anticholinergic burden, particularly in those taking other medications with 
      anticholinergic properties. With a mechanism of action distinct from 
      antimuscarinics, mirabegron has a different tolerability profile and does not 
      contribute to anticholinergic burden. The objective of this review was to compare 
      and contrast the tolerability profiles of antimuscarinics and mirabegron in older 
      patients to inform practice. METHODS: Prospective trials or retrospective 
      subgroup analyses of antimuscarinics for the treatment of OAB in older patients 
      were identified through a search of PubMed. Tolerability data and results of 
      subgroup analyses of mirabegron in patients aged >/=65 and >/=75 years from a pooled 
      analysis of three trials each of 12 weeks and a 1 year trial are described. 
      RESULTS: Anticholinergic adverse events (AEs) including dry mouth and 
      constipation were more frequent with antimuscarinics versus mirabegron. In 
      patients aged >/=65 years, dry mouth occurred with a six-fold higher incidence with 
      tolterodine extended-release (ER) 4 mg than with mirabegron 25 mg or 50 mg over 
      12 weeks, and a three-fold higher incidence with tolterodine ER than mirabegron 
      50 mg over 1 year. Mirabegron had a low incidence of central nervous system 
      effects. A systematic review of the cardiovascular safety profile of mirabegron 
      has not identified any clinically significant effects on blood pressure or pulse 
      rate at therapeutic doses amongst patients aged >/=65 years. CONCLUSIONS: 
      Mirabegron has a more favorable tolerability profile than antimuscarinics amongst 
      older patients and may provide an improved benefit-to-risk ratio and therefore be 
      considered as an alternative to antimuscarinics for older patients.
FAU - Wagg, Adrian
AU  - Wagg A
AD  - a University of Alberta , Edmonton , Canada ;
FAU - Nitti, Victor W
AU  - Nitti VW
AD  - b New York University , USA ;
FAU - Kelleher, Con
AU  - Kelleher C
AD  - c Guy's and St Thomas' NHS Foundation Trust , UK ;
FAU - Castro-Diaz, David
AU  - Castro-Diaz D
AD  - d University Hospital of the Canary Islands , Spain ;
FAU - Siddiqui, Emad
AU  - Siddiqui E
AD  - e Astellas Pharma Europe Ltd , Chertsey , Surrey , UK ;
FAU - Berner, Todd
AU  - Berner T
AD  - f Formerly of Astellas Scientific and Medical Affairs , Northbrook , IL , USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20160217
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Acetanilides)
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Benzhydryl Compounds)
RN  - 0 (Muscarinic Antagonists)
RN  - 0 (Thiazoles)
RN  - 5T619TQR3R (Tolterodine Tartrate)
RN  - 621G617227 (fesoterodine)
RN  - KKA5DLD701 (Solifenacin Succinate)
RN  - MVR3JL3B2V (mirabegron)
SB  - IM
MH  - Acetanilides/*administration & dosage
MH  - Administration, Oral
MH  - Adrenergic beta-Antagonists/administration & dosage
MH  - Aged
MH  - Benzhydryl Compounds/adverse effects
MH  - Blood Pressure
MH  - Clinical Trials as Topic
MH  - Constipation/chemically induced
MH  - Female
MH  - Heart Rate
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Muscarinic Antagonists/*adverse effects
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Solifenacin Succinate/adverse effects
MH  - Thiazoles/*administration & dosage
MH  - Tolterodine Tartrate/adverse effects
MH  - Urinary Bladder, Overactive/*drug therapy
OTO - NOTNLM
OT  - Antimuscarinic
OT  - Older
OT  - Overactive bladder
OT  - Tolerability
OT  - beta3-adrenoceptors
EDAT- 2016/02/02 06:00
MHDA- 2016/12/15 06:00
CRDT- 2016/02/02 06:00
PHST- 2016/02/02 06:00 [entrez]
PHST- 2016/02/02 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
AID - 10.1185/03007995.2016.1149806 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2016;32(4):621-38. doi: 10.1185/03007995.2016.1149806. Epub 
      2016 Feb 17.