Mirabegron-solifenacin combo safe, effective for overactive bladder

Mirabegron in combination with solifenacin is effective against overactive bladder (OAB) and comes with a good tolerability profile, a recent study has shown.

Researchers conducted a literature search of the databases of Embase, Cochrane and Medline for studies reporting on the efficacy and safety of antimuscarinic agents either in combination with each other or with a β3-adrenoreceptor agonists for OAB. Twenty-one publications, one of which was a conference abstract, were deemed eligible for inclusion.

One phase II trial was included, which employed a double-blind, placebo- and monotherapy-controlled, dose-ranging design. Compared with 5-mg solifenacin monotreatment, all combinations of 5- and 10-mg solifenacin with any dose of mirabegron resulted in significantly better mean volume voided per micturition.

Three combinations―10-mg solifenacin and 25-mg mirabegron, 5-mg solifenacin and 50-mg mirabegron, and 10-mg solifenacin and 50-mg mirabegron―significantly reduced micturition frequency from baseline. Aside from a slightly elevated frequency of constipation in patients treated with combination medication, no significant treatment-emergent adverse events were reported.

Three phase III/IIIb trials of mirabegron with solifenacin were included. Taken together, these studies showed that in treatment-naïve patients, the combination of solifenacin with mirabegron successfully reduced urinary incontinence episodes and micturitions relative to corresponding monotherapy doses.

The combination was also effective in those with initially inadequate responses to solifenacin alone and received mirabegron as an add-on.

These improvements in medication efficacy did not come with significant tradeoff, as no adverse event occurred with a significantly greater frequency in those receiving combination intervention.