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Wang J, Zhang A, Ye M, Zhang C. Examining the safety of mirabegron: an analysis of real-world pharmacovigilance data from the US FDA adverse event reporting system (FAERS) database. Front Pharmacol 2024; 15:1376535. [PMID: 38562462 PMCID: PMC10982368 DOI: 10.3389/fphar.2024.1376535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Background: Mirabegron, the first β-3 adrenergic receptor agonist, received approval from the Food and Drug Administration (FDA) in 2012 for the treatment of overactive bladder (OAB). This pharmacovigilance study investigated the safety profile of mirabegron treatment using the US FDA Adverse Event Reporting System (FAERS) database. Methods: This study employed disproportionality analyses, including the reporting odds ratio (ROR) and Bayesian Confidence Propagation Neural Network (BCPNN) algorithm, to quantify signals of adverse events associated with mirabegron. Results: From the first quarter of 2012 to the third quarter of 2023, a comprehensive total of 14,356,234 adverse event (AE) reports were submitted to the FDA Adverse Event Reporting System database. Within this dataset, encompassing 18,763 reports specifically associated with mirabegron, healthcare professionals notably contributed 2,902 of these reports. A total of 80 preferred terms (PTs) of interest were identified using both the ROR and information component algorithms. The most common AEs included blood pressure increased, urinary retention, atrial fibrillation, dry mouth, and tachycardia, which were consistent with the product instructions. Unexpected significant AEs, such as arrhythmia, palpitations, dementia, transient ischemic attack, Parkinson's disease, anti-neutrophil cytoplasmic antibody positive vasculitis, lip swelling, and swollen tongue, were also identified. The study findings indicated that the majority of onset time occurred within 30 days (n = 358, 55.68%). However, AEs were still possible after 1 year of mirabegron treatment. Conclusion: This study provided valuable evidence for the real-world safety of mirabegron, helping clinical professionals enhance their understanding of mirabegron's safety in clinical practice. It also contributed valuable evidence for further safety studies on mirabegron.
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Affiliation(s)
- Junwei Wang
- Department of Urology, Wenling Hospital Affiliated to Wenzhou Medical University (The First People’s Hospital of Wenling), Taizhou, Zhejiang, China
| | - Aiwei Zhang
- Department of Ultrasound, Wenling Hospital Affiliated to Wenzhou Medical University (The First People’s Hospital of Wenling), Taizhou, Zhejiang, China
| | - Miaoyong Ye
- Department of Urology, Wenling Hospital Affiliated to Wenzhou Medical University (The First People’s Hospital of Wenling), Taizhou, Zhejiang, China
| | - Cunming Zhang
- Department of Urology, Wenling Hospital Affiliated to Wenzhou Medical University (The First People’s Hospital of Wenling), Taizhou, Zhejiang, China
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Zhou Z, Wang X, Li X, Liao L. Detrusor relaxing agents for neurogenic detrusor overactivity: a systematic review, meta-analysis and network meta-analysis. BJU Int 2024; 133:25-33. [PMID: 37500569 DOI: 10.1111/bju.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To evaluate the evidence regarding the therapeutic benefits and safety of oral detrusor relaxing agents (DRAs) in treating neurogenic detrusor overactivity (NDO). METHODS A comprehensive search was performed on 1 September 2022. Two authors independently reviewed the articles to extract data using a pre-designed form. The meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A common-effect or random-effects model was used based on the heterogeneity among studies. Bayesian network meta-analysis (NMA) was further performed to make indirect comparisons of antimuscarinics and mirabegron. RESULTS A total of 23 randomised controlled trials (RCTs) comprising 1697 patients were included in our analysis. Compared to placebo, the clinical benefits of oral DRAs, along with more adverse events (AEs), were demonstrated in the treatment of NDO. In the subgroup analysis, antimuscarinics significantly improved both urodynamic and bladder diary outcomes (including urinary incontinence episodes, urinary frequency, and residual volume), with a higher rate of AEs, such as xerostomia. Mirabegron improved some of the parameters and had fewer bothersome side-effects in patients with NDO. The NMA showed that none of the antimuscarinics or mirabegron was superior or inferior to the other. CONCLUSIONS Detrusor relaxing agents are associated with improved outcomes in patients with NDO and our analysis has added new evidence regarding antimuscarinics. Evidence concerning mirabegron as first-line therapy for NDO is still limited. Well-designed RCTs are still required in this specific population.
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Affiliation(s)
- Zhonghan Zhou
- Shandong University, Jinan, Shandong, China
- Department of Urology, China Rehabilitation Research Center, Beijing, China
- China Rehabilitation Science Institute, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Xuesheng Wang
- Department of Urology, China Rehabilitation Research Center, Beijing, China
- China Rehabilitation Science Institute, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Xunhua Li
- Department of Urology, China Rehabilitation Research Center, Beijing, China
- China Rehabilitation Science Institute, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, Beijing, China
- China Rehabilitation Science Institute, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
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Akkoc Y. Efficacy and safety of mirabegron for treatment of neurogenic detrusor overactivity in adults with spinal cord injury or multiple sclerosis: a systematic review. Spinal Cord 2022; 60:854-861. [PMID: 36085413 DOI: 10.1038/s41393-022-00853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To evaluate the efficacy and safety of mirabegron in patients with neurogenic detrusor overactivity due to SCI or MS. METHODS A comprehensive search of the Pubmed, Cochrane, Scopus, and Embase databases was performed. Studies evaluating adult patients with neurogenic detrusor overactivity due to SCI or MS were analyzed according to clinical and urodynamic outcome parameters. RESULTS A total of 488 patients were included in 11 studies, with sample sizes ranging from 15 to 91. The duration of the treatments varied from 4 weeks to 12 months. Mirabegron was used as a secondline treatment after anticholinergics in most of the studies. While clinical outcome parameters are used in studies involving only MS patients, urodynamic outcome parameters are also used in studies involving patients with SCI. The efficacy of mirabegron was found not to be different than anticholinergics when compared in MS patients. Comprehensive urodynamic evaluation was performed in 2 randomized, double-blind, placebo-controlled studies and no satisfactory results were obtained compared to placebo. In retrospective studies there were some significant improvements in Pdet(max), MCC and compliance. The major safety concern with mirabegron is cardiovascular safety. In one study, tachyarrhythmia and palpitations reported in a patient with SCI at C6 level, in another study tachycardia reported in one patient with MS. CONCLUSIONS Although mirabegron demonstrates similar clinical efficacy to anticholinergics in MS patients, its effect on urodynamic parameters in patients with SCI cannot be considered satisfactory. It has a good safety profile with mild cardiovascular side effects.
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Affiliation(s)
- Yesim Akkoc
- Department of Physical Medicine and Rehabilitation, Ege University Medical Faculty, Izmir, Turkey.
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Krhut J, Skugarevská B, Míka D, Lund L, Zvara P. Clinical Utility of β3-Adrenoreceptor Agonists for the Treatment of Overactive Bladder: A Review of the Evidence and Current Recommendations. Res Rep Urol 2022; 14:167-175. [PMID: 35502186 PMCID: PMC9056051 DOI: 10.2147/rru.s309144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022] Open
Abstract
This nonsystematic review provides a summary of current evidence on the use of β3-adrenoreceptor agonists (β3-ARAs) for the treatment for lower urinary tract symptoms. Soon after their discovery in 1989, β3-ARs were identified as a predominant adrenoreceptor subtype in the human urinary bladder. Although it is widely believed that β3-ARAs cause detrusor relaxation, the effect on bladder afferent signaling likely plays an important role in their mechanism of action as well. In 2011 and 2012, mirabegron was approved for clinical use in overactive bladder (OAB) patients. Pooled analysis of data from prospective randomized studies on >60,000 OAB patients showed that when compared to placebo, mirabegron was superior with respect to reducing the frequency, number, and severity of urgency episodes, number of incontinence episodes and increasing dry rate, but not in reduction of nocturia episodes. The only side effect showing significantly higher incidence than placebo was nasopharyngitis. Mirabegron is approved for OAB treatment in all age-groups and in pediatric patients with neurogenic bladder. Vibegron is another β3-ARA approved for OAB treatment in the US and Japan. Several large, multicenter, double-blind, randomized trials have documented statistically significant superiority of vibegron over placebo on all efficacy end points. Other β3-ARAs are being developed; however, to date none has been introduced to clinical use. All β3-ARAs provide efficacy similar to anticholinergics. They have a favorable safety profile and are well tolerated. Due to their different mechanisms of action, combination of β3-ARAs with anticholinergic compounds allows for increased efficacy.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic
- Correspondence: Jan Krhut, Department of Urology, University Hospital, Tř 17 Listopadu 1790, Ostrava70852, Czech Republic, Tel +420 59-737-5307, Fax +420 59-737-5301, Email
| | - Barbora Skugarevská
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - David Míka
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - Lars Lund
- Research Unit of Urology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Peter Zvara
- Research Unit of Urology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Urology, Odense University Hospital, Odense, Denmark
- Biomedical Laboratory, University of Southern Denmark, Odense, Denmark
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Syed MUS, Khan Z, Zulfiqar A, Basham MA, Abdul Haseeb H, Azizullah S, Ismail H, Elbahnasawy M, Nadeem Z, Karimi S. Electrocardiographic Abnormalities in Patients With Spinal Cord Injury With Deranged Lipid Profile. Cureus 2021; 13:e18246. [PMID: 34722039 PMCID: PMC8544921 DOI: 10.7759/cureus.18246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Spinal cord injury (SCI) can lead to severe disability and neurogenic shock, arrhythmias, autonomic dysfunction, pressure ulcers, etc., of the autonomic nervous system. Therefore, in these patients, cardiovascular problems should be investigated frequently. This study was conducted to evaluate the electrocardiographic (ECG) abnormalities in patients with spinal cord injury having inappropriate lipid profiles and their relationship with each other. Materials and methods This cross-sectional study was held in the Internal Medicine Department of Mayo Hospital, Lahore, for a one-year duration from May 2020 to May 2021. It included 58 patients with spinal cord injury, 35 of whom had paraplegia, and 23 had tetraplegia. Fasting blood samples were taken for lipid profile analysis. Twelve-lead ECGs three times a day for one month were taken and analyzed in the context of previously available ECGs. Results Out of 58, the lipid profiles were found abnormal in 47 patients, 18 of whom had a normal ECG. The lipid profile was normal in 12, of which only one patient had ECG abnormalities. Cholesterol levels were found normal in 39 patients and deranged in 19 patients; low-density lipoproteins in nine patients, triglycerides in 18 patients, and high-density lipoprotein values in one patient were abnormal. Conclusions Sinus bradycardia was the most common ECG abnormality found in SCI patients with deranged lipid profiles. Further studies are needed in the future to validate the findings of this study.
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Affiliation(s)
| | - Zunaira Khan
- Accident and Emergency, Kingston Hospital, London, GBR
| | - Arif Zulfiqar
- Internal Medicine, Dow Medical College, Karachi, PAK
| | | | | | - Saad Azizullah
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hebatalla Ismail
- Medicine and Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Mohammad Elbahnasawy
- Internal Medicine, Alexandria Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Zubia Nadeem
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sundas Karimi
- Orthopedic Surgery, Dow University of Health Sciences, Karachi, PAK
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