使用貝坦利治療逼尿肌過動及收縮力不足患者的效果和安全性

李政霖、郭漢崇

花蓮慈濟醫院 泌尿部

Efficiency and safety of mirabegron in patients with urodynamic detrusor overactivity and inadequate detrusor contractility

Cheng-Ling Lee, Hann-Chorong Kuo

Divisions of Urology, Buddhist Tzu-Chi General Hospital, Hualein, Taiwan

Purpose: Detrusor overactivity (DO) and inadequate detrusor contractility (DHIC) are not uncommon in frail and old. Use of antimuscarinics in these population is often limited given high incidence of adverse events (AEs). Mirabegron, a selective β3-adrenoceptor agonist, is recently approved for treating overactive bladder which has a different mechanism of action from antimuscarinic agents. In this study, we aimed to examine the efficacy and safety of mirabegron in patients with DO and DHIC.

Materials and Methods: We enrolled a total of 213 patients with videourodynamic (VUDS) evidence of DO and DHIC. Exclusion criteria including those with neurogenic bladder, bladder outlet obstruction and acontractile bladder. Patients who formerly exposed to antimuscarinic agents were also precluded from this study. All patients were then given a daily dose of 25mg mirabegron orally. Their subjective symptom outcome, uroflowmetry data and reported AEs were documented at baseline, 1 and 3 months and compared..

Results: 28 patients were eligible for inclusion in this study. 19 patients had findings consistent with DO and 9 patients had DHIC. The mean age for each group was 70.1±15.9 and 73.3± 8.6 years old, respectively. At 3-month follow-up, use of mirabegron in both DO and DHIC groups demonstrated significantly improvement in IPSS-S, OABSS, USS, PPBC and GRA compared to baseline (P< 0.05). PVR was not increased (Table.1). Improvement of symptoms score at 3 month was not inferior in DHIC group in comparison to DO group (Table.2). The most common AEs were dry mouth and dizziness. Incidence of AEs was not significantly increased in DHIC group after taking 3-month daily dose of mirabegron (Table.3).

Conclusions: Use of mirabegron is considered as effective option in treatment-naive patients with urodynamic DO, even in those with DHIC. AEs were generally mild and infrequent.