A Prospective Paired Comparison Trial of Mirabegron and Anticholinergics in Patients With Low Bladder Compliance
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Purpose: Low bladder compliance (BC) poses a significant clinical challenge. Nevertheless, studies exploring pharmacological mechanisms to improve BC remain limited. We investigated the efficacy of a β3-adrenoceptor agonist, mirabegron, on BC in comparison with anticholinergics. Methods: This prospective single-arm paired comparison trial included 14 patients with low BC (≤20 mL/cm H2O) despite anticholinergics treatment. After a 2-week anticholinergics-washout period, patients were treated with mirabegron for 8 weeks and then returned to 8 weeks of anticholinergics. Major treatment effect was assessed with urodynamic studies performed at baseline, 8 weeks after mirabegron treatment, and 8 weeks after consecutive anticholinergics treatment (McNemar test, Paired t-test; mean [95% confidence intervals]). Results: Following mirabegron, 71.43% of patients exhibited a BC of >20 mL/cm H₂O, compared to 54.55% after switching back to anticholinergics (P=0.317). BC improved significantly from 12.02 (9.52–14.52) to 39.67 (21.60–57.73) mL/cm H2O after mirabegron treatment (P=0.007), but subsequently declined to 20.94 (15.78–26.10) mL/cm H₂O after reintroduction of anticholinergics (P=0.075). Maximum cystometric capacity increased from 352.21 (282.78–421.65) to 442.71 (348.95–536.48) mL after mirabegron (P=0.091), but decreased to 402.00 (315.92–488.08) mL after returning to anticholinergics (P=0.218). Notably, detrusor pressure at end-filling decreased significantly with mirabegron, from 30.50 (25.61–35.39) to 14.43 (10.79 18.06) cm H2O (P<0.001), while increasing to 20.36 (16.26–24.46) cm H2O after returning to anticholinergics (P=0.056). Conclusions: A β3-adrenoceptor agonist, mirabegron, was more effective than anticholinergics in improving BC. Among the two components of improved BC—increased bladder volume and reduced detrusor filling pressure—the β3-adrenoceptor agonist showed a more pronounced effect on lowering detrusor filling pressure, compared to anticholinergics. These findings suggest that β3-adrenoceptor agonists might play an important role in reducing the tension of the bladder wall by controlling detrusor muscle tone, and this may be an important target for future research.
Abstract
Purpose: Low bladder compliance (BC) poses a significant clinical challenge. Nevertheless, studies exploring pharmacological mechanisms to improve BC remain limited. We investigated the efficacy of a β3-adrenoceptor agonist, mirabegron, on BC in comparison with anticholinergics. Methods: This prospective single-arm paired comparison trial included 14 patients with low BC (≤20 mL/cm H2O) despite anticholinergics treatment. After a 2-week anticholinergics-washout period, patients were treated with mirabegron for 8 weeks and then returned to 8 weeks of anticholinergics. Major treatment effect was assessed with urodynamic studies performed at baseline, 8 weeks after mirabegron treatment, and 8 weeks after consecutive anticholinergics treatment (McNemar test, Paired t-test; mean [95% confidence intervals]). Results: Following mirabegron, 71.43% of patients exhibited a BC of >20 mL/cm H₂O, compared to 54.55% after switching back to anticholinergics (P=0.317). BC improved significantly from 12.02 (9.52–14.52) to 39.67 (21.60–57.73) mL/cm H2O after mirabegron treatment (P=0.007), but subsequently declined to 20.94 (15.78–26.10) mL/cm H₂O after reintroduction of anticholinergics (P=0.075). Maximum cystometric capacity increased from 352.21 (282.78–421.65) to 442.71 (348.95–536.48) mL after mirabegron (P=0.091), but decreased to 402.00 (315.92–488.08) mL after returning to anticholinergics (P=0.218). Notably, detrusor pressure at end-filling decreased significantly with mirabegron, from 30.50 (25.61–35.39) to 14.43 (10.79 18.06) cm H2O (P<0.001), while increasing to 20.36 (16.26–24.46) cm H2O after returning to anticholinergics (P=0.056). Conclusions: A β3-adrenoceptor agonist, mirabegron, was more effective than anticholinergics in improving BC. Among the two components of improved BC—increased bladder volume and reduced detrusor filling pressure—the β3-adrenoceptor agonist showed a more pronounced effect on lowering detrusor filling pressure, compared to anticholinergics. These findings suggest that β3-adrenoceptor agonists might play an important role in reducing the tension of the bladder wall by controlling detrusor muscle tone, and this may be an important target for future research.