Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Efficacy and safety of mirabegron for treatment of neurogenic detrusor overactivity in adults with spinal cord injury or multiple sclerosis: a systematic review

Abstract

Study design

Systematic review.

Objective

To evaluate the efficacy and safety of mirabegron in patients with neurogenic detrusor overactivity due to SCI or MS.

Methods

A comprehensive search of the Pubmed, Cochrane, Scopus, and Embase databases was performed. Studies evaluating adult patients with neurogenic detrusor overactivity due to SCI or MS were analyzed according to clinical and urodynamic outcome parameters.

Results

A total of 488 patients were included in 11 studies, with sample sizes ranging from 15 to 91. The duration of the treatments varied from 4 weeks to 12 months. Mirabegron was used as a secondline treatment after anticholinergics in most of the studies. While clinical outcome parameters are used in studies involving only MS patients, urodynamic outcome parameters are also used in studies involving patients with SCI. The efficacy of mirabegron was found not to be different than anticholinergics when compared in MS patients. Comprehensive urodynamic evaluation was performed in 2 randomized, double-blind, placebo-controlled studies and no satisfactory results were obtained compared to placebo. In retrospective studies there were some significant improvements in Pdet(max), MCC and compliance. The major safety concern with mirabegron is cardiovascular safety. In one study, tachyarrhythmia and palpitations reported in a patient with SCI at C6 level, in another study tachycardia reported in one patient with MS.

Conclusions

Although mirabegron demonstrates similar clinical efficacy to anticholinergics in MS patients, its effect on urodynamic parameters in patients with SCI cannot be considered satisfactory. It has a good safety profile with mild cardiovascular side effects.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1: Study design.

Data availability

All data generated or analysed during this study are included in this published article (and its Supplementary Information file).

References

  1. Fowler CJ, Dalton C, Panicker JN. Review of neurologic diseases for the urologist. Urol Clin North Am. 2010;37:517–26.

    Article  Google Scholar 

  2. Mete UK, Powell CR. Review of current neurogenic bladder best practices and international guidelines. Curr Bladder Dysfunct Rep. 2020;15:283–95.

    Article  Google Scholar 

  3. Cooley LF, Kielb S. A review of botulinum toxin a for the treatment of neurogenic bladder. Pmr. 2019;11:192–200.

    Google Scholar 

  4. Kashyap M, Tyagi P. The pharmacokinetic evaluation of mirabegron as an overactive bladder therapy option. Expert Opin Drug Metab Toxicol. 2013;9:617–27.

    Article  CAS  Google Scholar 

  5. El Helou E, Labaki C, Chebel R, El Helou J, Abi Tayeh G, Jalkh G, et al. The use of mirabegron in neurogenic bladder: a systematic review. World J Urol. 2020;38:2435–42.

    Article  Google Scholar 

  6. Wöllner J, Pannek J. Initial experience with the treatment of neurogenic detrusor overactivity with a new β-3 agonist (mirabegron) in patients with spinal cord injury. Spinal Cord. 2016;54:78–82.

    Article  Google Scholar 

  7. Welk B, Hickling D, McKibbon M, Radomski S, Ethans K. A pilot randomized-controlled trial of the urodynamic efficacy of mirabegron for patients with neurogenic lower urinary tract dysfunction. Neurourol Urodyn. 2018;37:2810–7.

    Article  CAS  Google Scholar 

  8. Krhut J, Borovička V, Bílková K, Sýkora R, Míka D, Mokriš J, et al. Efficacy and safety of mirabegron for the treatment of neurogenic detrusor overactivity-Prospective, randomized, double-blind, placebo-controlled study. Neurourol Urodyn. 2018;37:2226–33.

    Article  CAS  Google Scholar 

  9. Zachariou A, Filiponi M, Baltogiannis D, Giannakis J, Dimitriadis F, Tsounapi P, et al. Effective treatment of neurogenic detrusor overactivity in multiple sclerosis patients using desmopressin and mirabegron. Can J Urol. 2017;24:9107–13.

    PubMed  Google Scholar 

  10. Chen SF, Kuo HC. Therapeutic efficacy of low-dose (25 mg) mirabegron therapy for patients with mild to moderate overactive bladder symptoms due to central nervous system diseases. Low Urin Tract Symptoms. 2019;11:O53–8.

    Article  CAS  Google Scholar 

  11. Matsuo T, Miyata Y, Nakamura T, Satoh K, Sakai H. Efficacy of mirabegron for overactive bladder with human T cell lymphotropic virus-1 associated myelopathy. Low Urin Tract Symptoms. 2019;11:O65–70.

    Article  CAS  Google Scholar 

  12. Park JS, Lee YS, Lee CN, Kim SH, Kim SW, Han SW. Efficacy and safety of mirabegron, a β3-adrenoceptor agonist, for treating neurogenic bladder in pediatric patients with spina bifida: a retrospective pilot study. World J Urol. 2019;37:1665–70.

    Article  CAS  Google Scholar 

  13. Stohrer M, Blok B, Castro-Diaz D, Chartier-Kastler E, Del Popolo G, Kramer G, et al. EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol. 2009;56:81–8.

    Article  Google Scholar 

  14. Madersbacher H, Murtz G, Stohrer M. Neurogenic detrusor overactivity in adults: a review on efficacy, tolerability and safety of oral antimuscarinics. Spinal Cord. 2013;51:432–41.

    Article  CAS  Google Scholar 

  15. Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol. 2018;50:1005–16.

    Article  Google Scholar 

  16. Kreydin E, Welk B, Chung D, Clemens Q, Yang C, Danforth T, et al. Surveillance and management of urologic complications after spinal cord injury. World J Urol. 2018;36:1545–53.

    Article  Google Scholar 

  17. Zhang D, Sun F, Yao H, Bao X, Wang D, Cui Y, et al. The efficacy and safety of mirabegron for the treatment of neurogenic lower urinary tract dysfunction: a systematic review and meta-analysis. Front Pharmacol. 2021;12:756582.

    Article  CAS  Google Scholar 

  18. Cho SY, Jeong SJ, Lee S, Kim J, Lee SH, Choo MS, et al. Mirabegron for treatment of overactive bladder symptoms in patients with Parkinson’s disease: a double-blind, randomized placebo-controlled trial (Parkinson’s Disease Overactive bladder Mirabegron, PaDoMi Study). Neurourol Urodyn. 2021;40:286–94.

    Article  Google Scholar 

  19. Brucker BM, Kalra S. Parkinson’s disease and its effect on the lower urinary tract: evaluation of complications and treatment strategies. Urol Clin North Am. 2017;44:415–28.

    Article  Google Scholar 

  20. Gray R, Stern G, Malone-Lee J. Lower urinary tract dysfunction in Parkinson’s disease: changes relate to age and not disease. Age Ageing. 1995;24:499–504.

    Article  CAS  Google Scholar 

  21. Vurture G, Peyronnet B, Palma JA, Sussman RD, Malacarne DR, Feigin A, et al. Urodynamic mechanisms underlying overactive bladder symptoms in patients with Parkinson disease. Int Neurourol J. 2019;23:211–8.

    Article  Google Scholar 

  22. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.

    Article  Google Scholar 

  23. Glykas I, Fragkoulis C, Mitsikostas DD, Papatsoris A, Mitsogiannis I, Papadopoulos G, et al. B3 agonists or anticholinergics in the treatment of the lower urinary tract dysfunction in patients with multiple sclerosis? A randomized study. World J Urol. 2021;39:3049–56.

    Article  CAS  Google Scholar 

  24. Vasudeva P, Prasad V, Yadav S, Kumar N, Saurav K, Prashanth YM, et al. Efficacy and safety of mirabegron for the treatment of neurogenic detrusor overactivity resulting from traumatic spinal cord injury: a prospective study. Neurourol Urodyn. 2021;40:666–71.

    Article  CAS  Google Scholar 

  25. Trbovich M, Romo T, Polk M, Koek W, Kelly C, Stowe S, et al. The treatment of neurogenic lower urinary tract dysfunction in persons with spinal cord injury: an open label, pilot study of anticholinergic agent vs. mirabegron to evaluate cognitive impact and efficacy. Spinal Cord Ser Cases. 2021;7:50.

    Article  Google Scholar 

  26. Brucker BM, Jericevic D, Rude T, Enemchukwu E, Pape D, Rosenblum N, et al. Mirabegron versus Solifenacin in multiple sclerosis patients with overactive bladder symptoms: a prospective comparative nonrandomized study. Urology. 2020;145:94–9.

    Article  Google Scholar 

  27. Krebs J, Pannek J, Rademacher F, Wöllner J. Real-world effects of mirabegron in patients with chronic neurogenic detrusor overactivity—a retrospective cohort study. Res Rep Urol. 2020;12:187–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Han SH, Cho IK, Jung JH, Jang SH, Lee BS. Long-term efficacy of mirabegron add-on therapy to antimuscarinic agents in patients with spinal cord injury. Ann Rehabil Med. 2019;43:54–61.

    Article  Google Scholar 

  29. Krhut J, Wohlfahrt P, Pudich J, Kufová E, Borovička V, Bílková K, et al. Cardiovascular safety of mirabegron in individuals treated for spinal cord injury- or multiple sclerosis-induced neurogenic detrusor overactivity. Int Urol Nephrol. 2021;53:1089–95.

    Article  Google Scholar 

  30. McGuire EJ, Woodside JR, Borden TA, Weiss RM. Prognostic value of urodynamic testing in myelodysplastic patients. J Urol. 1981;126:205–9.

    Article  CAS  Google Scholar 

  31. Hadiji N, Previnaire JG, Benbouzid R, Robain G, Leblond C, Mieusset R, et al. Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients? Spinal Cord. 2014;52:701–5.

    Article  CAS  Google Scholar 

  32. Yamano Y, Sato T. Clinical pathophysiology of human T-lymphotropic virus-type 1-associated myelopathy/tropical spastic paraparesis. Front Microbiol. 2012;3:389.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yesim Akkoc.

Ethics declarations

Competing interests

The author declares no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Akkoc, Y. Efficacy and safety of mirabegron for treatment of neurogenic detrusor overactivity in adults with spinal cord injury or multiple sclerosis: a systematic review. Spinal Cord 60, 854–861 (2022). https://doi.org/10.1038/s41393-022-00853-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41393-022-00853-3

Search

Quick links