Mirabegron和Antimuscarinic agents的比較-系統性文獻回顧及統合分析
李香瑩1、陳筱玲2、阮雍順1、吳文正1
1高雄市立大同醫院泌尿科；2高雄市立大同醫院藥劑科，3高雄市立大同醫院感染科Comparison between Mirabegron and Antimuscarinic agents – Systemic Review and Meta-Analysis
Hsiang Ying Lee1, Hsiao Ling Chen2, Yung-Shun Juan1, Wen-Jeng Wu1
1Department of Urology, 2Department of Pharmacy, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
Purpose: Antimuscarinic drugs have been the first line choice of overactive bladder (OAB) treatment for a long time; however, side effects were clearly a major reason for noncompliance. Mirabegron, a β3-adrenoceptor agonist, was investigated to be effective and safe for OAB.
Aims: To perform a meta-analysis on the efficacy comparison between antimuscarinics and mirabegron.
Methods: A systematic literature search was conducted in PubMed, EU Clinical Trials, ClinicalTrials.gov, and EMBASE. The last search was run in March 2017. Published randomized controlled trials (RCTs) for OAB with mirabegron and antimuscarinics (ex. darifenacin, tolterodine, oxybutynin, trospium, solifenacin, and fesoterodine) were identified. Cochrane risk of bias tool was used to assess the potential bias and RevMan5 software was performed for pooling the results.
Results: The review included 10 RCTs (3 RCTs for Mirabegron V.S. Solifenacin and 7 RCTs for Mirabegron V.S. Tolterodine). We compared the efficacy between once daily use of Mirabegron 50 mg and Tolterodine 4 mg. Outcome were calculated by means difference (MD), and there were no statistical difference in all indicators (micturitions : MD=-0.16, 95% CI: -0.50 to 0.19 ; incontinence: MD=-0.07, 95% CI: -0.24 to 0.10 ; urgency incontinence : MD=-0.01, 95% CI: -0.17 to 0.15; GRADE 3 or 4 urgency : MD=0.04, 95% CI: -0.20 to 0.08; nocturia: MD=-0.04, 95% CI: -0.12 to 0.03). Outcomes from once daily use of Mirabegron 50 mg and Solifenacin 5 mg were pooled in meta-analysis. It showed there were no statistical difference in all indicators (micturitions: MD=0.17, 95% CI: -0.02 to 0.36; incontinence: MD=-0.10, 95% CI: -0.11 to 0.31; urgency incontinence: MD=-0.09, 95% CI: -0.03 to 0.21; GRADE 3 or 4 urgency : MD=0.04, 95% CI: -0.55 to 0.64; nocturia: MD=-0.00, 95% CI: -0.07 to 0.07).
Conclusion: Mirabegron 50mg had similar efficacy to Tolterodine 4mg and Solifenacin 5 mg, but evidences were limited for efficacy comparisons between Mirabegron and other antimuscarinics. Mirabegron could be considered as an alternative for OAB, especially in patients who could not tolerate side effects of antimuscarinics.