Wagg A, et al. CMRO.

28 July 2016; 15:14

 Prospective trials or retrospective subgroup analyses of antimuscarinics for the
treatment of OAB in older patients were identified through a search of
PubMed.
 Tolerability data and results of subgroup analyses of mirabegron in patients
aged 65 and 75 years from a pooled analysis of three trials each of 12 weeks
and a 1 year trial are described.
Safety Statement

 There are few if any b3-adrenoceptors in the human CNS which may explain the low
incidence of adverse CNS effects reported in the clinical trial program for mirabegron. 
a particular benefit in older patients at risk of cognitive decline
Encompassing more than 13,600 participants on monotherapy cumulatively over more than 10 years.

 Mirabegron may be a suitable treatment option in frail elderly (complex) patients 

improved tolerability profile and lack of contribution to the patient’s anticholinergic burden

 Antimuscarinics are associated with low persistence rates due to bothersome AEs including
dry mouth and constipation; mirabegron has a low incidence of these particular AEs.
Safety

 The CV safety profile of mirabegron has been found to be acceptable at therapeutic

doses.
 In the total patient population enrolled in the 1 year phase III study, reports of increased heart rate
were lower with mirabegron 50mg compared with tolterodine
 Using a consistent definition, the incidence of hypertension in the oldest patients (75 years) was
higher with tolterodine (14.5%) than mirabegron 50mg (9.3%) over a 1 year period
Persistance
 Experience in Canada  mirabegron indicates significantly improved 6 month persistence
rates compared with antimuscarinics
Median Medication Possesion Ratio

Mirabegron Anti Muscarinic

 with a median medication possession ratio (i.e., the percentage of time a patient has access to
medication) of 77% vs 32%–49% in OAB patients treated with mirabegron and antimuscarinics,
respectively.
 Furthermore, patients aged 65 years were on average 38% less likely to discontinue treatment than
those aged <46 years of age
Persistance

 A retrospective analysis of a large US medical claims database (Optum)

 Adult patients persisted with mirabegron for a significantly longer period compared with those
receiving tolterodine
 mirabegron led to a reduction in overall costs and resource utilization
 age 65 years was a significant factor associated with increased persistence with mirabegron
 Mirabegron has a more favorable tolerability profile than antimuscarinics amongst
older patients

 Mirabegron may provide an improved benefit-to-risk ratio and therefore be

considered as an alternative to antimuscarinics for older patients.

 The successful treatment of OAB is dependent on medication adherence, which is

affected by inadequate efficacy, bothersome adverse effects and cost of treatment