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Open Access Highly Accessed Research article

Efficacy of mirabegron in patients with and without prior antimuscarinic therapy for overactive bladder: a post hoc analysis of a randomized European-Australian Phase 3 trial

Vik Khullar1*, Javier Cambronero2, Javier C Angulo3, Marianne Wooning4, Mary Beth Blauwet5, Caroline Dorrepaal6 and Nancy E Martin7

Author Affiliations

1 Urogynaecology Department, St Mary’s Hospital, Imperial College, London, UK

2 Infanta Leonor Hospital, Department of Urology, Madrid, Spain

3 Hospital Universitario De Getafe, Department of Urology, Madrid, Spain

4 Astellas Pharma Global Development, Global Clinical Science, Leiden, The Netherlands

5 Astellas Pharma Global Development, Inc., Biostatistics, Northbrook, IL, USA

6 Astellas Pharma Global Development – EU, Global Medical Science – Urology, Leiden, The Netherlands

7 Astellas Pharma Global Development, Global Medical Sciences, Northbrook, IL, USA

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BMC Urology 2013, 13:45  doi:10.1186/1471-2490-13-45

Published: 18 September 2013

Abstract

Background

Antimuscarinic agents are currently the predominant treatment option for the clinical management of the symptoms of overactive bladder (OAB). However, low rates of persistence with these agents highlight the need for novel, effective and better-tolerated oral pharmacological agents. Mirabegron is a β3-adrenoceptor agonist developed for the treatment of OAB, with a mechanism of action distinct from that of antimuscarinics. In a randomized, double-blind, placebo- and active-controlled Phase 3 trial conducted in Europe and Australia (NCT00689104), mirabegron 50 mg and 100 mg resulted in statistically significant reductions from baseline to final visit, compared with placebo, in the co-primary end points – mean number of incontinence episodes/24 h and mean number of micturitions/24 h. We conducted a post hoc, subgroup analysis of this study in order to evaluate the efficacy of mirabegron in treatment-naïve patients and patients who had discontinued prior antimuscarinic therapy because of insufficient efficacy or poor tolerability.

Methods

Patients were randomized to placebo, mirabegron 50 or 100 mg, or tolterodine extended release (ER) 4 mg orally, once-daily, for 12 weeks. For the post hoc analysis, the primary patient population was divided into the following subgroups: (1) patients who had not received any prior antimuscarinic OAB medication (treatment-naïve) and (2) patients who had received prior antimuscarinic OAB medication. The latter subgroup was further subdivided into patients who discontinued due to: (3) insufficient efficacy or (4) poor tolerability. Analysis of the co-primary efficacy endpoints by subgroup was performed using analysis of covariance with treatment group, subgroup, sex, geographical region, and subgroup-by-treatment interaction as fixed factors; and baseline value as a covariate.

Results

Mirabegron, 50 mg and 100 mg once-daily, demonstrated similar improvements in the frequency of incontinence episodes and micturitions in OAB patients who were antimuscarinic-naïve and who had discontinued prior antimuscarinic therapy. While mirabegron demonstrated improvements in incontinence and micturition frequency in patients who had discontinued prior antimuscarinic therapy due to insufficient efficacy, the response to tolterodine was similar to that of placebo.

Conclusion

In this post hoc subgroup analysis, mirabegron provided treatment benefits in OAB patients who were antimuscarinic treatment-naïve and in patients who had received prior antimuscarinic treatment.

Keywords:
β3-adrenoceptor agonist; Mirabegron; OAB; Overactive bladder; Post hoc analysis