Mirabegron safe, effective for refractory neurogenic bladder in kids

Mirabegron is an effective adjuvant treatment in children with refractory neurogenic bladder, increasing their bladder capacity and helping them achieve continence, a recent study has found.

The study included 37 paediatric neurogenic bladder patients who were given mirabegron at a 25-mg/day dose. All participants were refractory to either oral oxybutynin or onabotulinumtoxin A. Outcomes included maximum cystometric capacity (MCC), urinary incontinence, and adverse effects, among others.

The researchers observed a significant improvement in mean MCC following mirabegron treatment, increasing from 322±102 to 466±138 mL (p<0.0001). End-filling detrusor pressure dropped by a significant 12±12 cm H₂O (p<0.0001). The frequency of urine leaks in the urodynamic studies dropped from 56 percent to 43 percent, and disappeared completely in 14 patients.

Participants or their parents/tutors were also asked to accomplish a voiding diary over two consecutive days. This showed that both the minimum (145±83 to 148±83 mL; p<0.86) and maximum (321±98 to 358±325 mL; p<0.18) volumes obtained by catheterization increased during therapy, but failed to reach statistical significance.

Urinary incontinence, on the other hand, saw significant improvements. The global number of incontinent children dropped from 18 to 5 during mirabegron therapy. Of the 18 patients who were initially incontinent, 72 percent (n=13) remained dry after treatment initiation. In terms of safety, no patient demonstrated any signs or symptoms of adverse events.

“Mirabegron was well tolerated, without side effects, which implied reducing or postponing the need for performing augmentation cystoplasty,” the researchers said. “Further prospective randomized studies are needed in order to investigate efficacy and safety of Mirabegron using different doses.”