Treatment Of OAB Research Articles

Structural and functional changes in gap junctional intercellular communication in a rat model of overactive bladder syndrome induced by partial bladder outlet obstruction.

The aim of the present study was to investigate the association between connexin (Cx)43 levels and alterations in gap junctional mediation of intercellular communication in overactive bladder syndrome (OAB), and to examine the effects of connexin inhibitor on this condition. Adult female Wistar rats with OAB following partial bladder outlet obstruction (PBBO) (OAB group, n=37) and sham-operated rats (control group, n=17) were studied. The ultrastructure of the rat detrusor was observed by transmission electron microscopy and the protein expression levels of Cx43 were analyzed using western blot analysis. Furthermore, bladder detrusor cells in both groups were cultured and cells in the OAB group were randomly divided into ten groups. In nine of these groups, 18-β glycyrrhetinic acid (18β-GA) was administered at various doses and durations. All groups were compared using fluorescence redistribution after photobleaching and a laser scanning confocal microscope. Cystometry demonstrated that gap junctions were an abundant mechanism among adjacent cells, and Cx43 protein expression levels were increased in the OAB group following 6 weeks of obstruction, as compared with the control group. Mean fluorescence recovery rates in the OAB group were significantly increased, as compared with the control group (P<0.01). Mean fluorescence recovery rates were noted following 18β-GA administration. These results suggested that upregulation of Cx43 induces structural and functional alterations in gap junctional intercellular communication following PBOO, and connexin inhibitors may be a novel therapeutic strategy for the clinical treatment of OAB.

The efficacy and tolerability of mirabegron in a non-trial clinical setting

ObjectivesMirabegron is the first β3-adrenoceptor selective agonist approved for the treatment of OAB. Many randomised controlled trials report outcomes that are difficult to interpret in usual clinical practice. The aim of our study is to evaluate the efficacy and tolerability of mirabegron as treatment option for OAB in an unselected patient population in daily clinical practice and to identify if any patient characteristics predicted patients response to therapy. Study designA prospective consecutive cohort of patients was studied between February 2013 and July 2014. Patients were prescribed Mirabegron 50mg once daily for 6 weeks. They were assessed at the initial appointment and at 6 weeks using validated questionnaires. The primary outcome measure was defined using the Patient Global Impression of Improvement Scale (PGI-I). Results317 women were prescribed mirabegron and 244 (77%) completed 6 weeks of drug therapy. Of those completing the course, 27 (11%) described themselves as “very much better” and a further 56 (23%) much better. There was significant symptom improvement based on the ICIQ-FLUTS long form scores from 19.7 to 16.2 (p<0.001) and urinary distress inventory from 68.6 to 61.3 (p<0.005). Twenty-three (8.6%) patients discontinued mirabegron prematurely due to side-effects. Thirty one (10%) did not attend follow up and 19 (6%) decided against taking the medication and did not use their prescription. ConclusionMirabegron is a treatment option for patients with overactive bladder. Treatment benefits are modest but the discontinuation rate for side effects are low.

Practical Aspects of Botulinum Toxin-A Treatment in Patients With Overactive Bladder Syndrome.

Intravesical onabotulinumtoxinA (BoNT-A) injection is an effective treatment for overactive bladder syndrome (OAB) that is refractory to antimuscarinics. An injectable dose of 100 U has been suggested to achieve the optimal balance of benefit and safety in patients with OAB. BoNT-A (total volume of 10 mL) was administered as evenly distributed intradetrusor injections (5 U) across 20 sites approximately 1 cm apart (0.5 mL per site) using a flexible or rigid cystoscope. Treatment with BoNT-A was generally well tolerated by most patients, and most treatment-related adverse events were localized to the urinary tract. The prevalence of OAB increases with age, and elderly patients are more vulnerable to complications. The short-term efficacy of intravesical BoNT-A injection for refractory OAB with no treatment-related complications in the elderly population has been documented. Frail elderly patients can experience the same treatment results, such as significantly improved urgent urinary incontinence and quality of life, as young and nonfrail elderly patients with 100-U BoNT-A injections. However, increased risk of larger postvoid residual (PVR) urine and lower long-term success rates were noted in frail elderly patients; around 11% had acute urinary retention, while 60% had PVR urine volume >150 mL after treatment. In addition, intravesical injection of BoNT-A effectively decreased urgency symptoms in elderly patients with OAB and central nervous system lesions. The adverse effects were acceptable, while the long-term effects were comparable to those in patients with OAB without central nervous system lesions. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization in this vulnerable population requires careful evaluation before treatment with intravesical BoNT-A. In conclusion, the current findings indicate that intravesical BoNT-A is an effective and safe treatment for OAB in elderly patients.

Impact of body mass index on treatment efficacy of mirabegron for overactive bladder in females

ObjectiveConclusive data comparing treatment efficacy of OAB pharmacotherapy in normal weight versus obese patients are not available. Obesity represents a risk factor for OAB/LUTS. We hypothesized that the effect of treatment with mirabegron might be diminished in obese patients. Study designOne hundred sixty nine women were prescribed mirabegron, 50mg/day. Subjective and objective parameters were compared prior to and following three months of treatment. The study population was stratified into three groups according to a patients’ BMI (A-normal weight, B-overweight, C-obese). We compared the change in parameters before and after treatment within each group. Subsequently the differences between groups were correlated. The same analysis was performed separately in patients who failed anticholinergic therapy (n=85). A paired t-test was used to compare the parameters before and after the procedure within groups, and a two-sample t-test was applied to conduct a comparison between groups. A p value of <0.05 was considered statistically significant. ResultsSignificant improvement (p<0.001) within all groups was observed in all parameters, with an exception in the number of severe urgency episodes per 24h (p=0.291) in Group B. We did not observe any statistically significant difference between groups A, B and C. The same trend has been observed in subgroup of patients, who did not respond previous antimuscarinic treatment. ConclusionsThis study provides evidence in support of previously documented data indicating good efficacy of mirabegron in the treatment of OAB. The data obtained do not confirm our hypothesis that the body weight influences the treatment outcome of mirabegron.

Documento de consenso sobre vejiga hiperactiva en el paciente mayor

Overactive nladder (OAB) is a clinical entity with a high prevalence in the population, having a high impact on quality of life, especially when it occurs with urge urinary incontinence.It is very important to highlight the low rate of consultation of this condition by the older population. This appears to depend on several factors (educational, cultural, professional), and thus leads to the low percentage of older patients who receive appropriate treatment and, on the other hand, a large percentage of older patients with a significant deterioration in their quality of life. Therefore, Scientific societies and Working Groups propose the early detection of OAB in their documents and clinical guidelines. Its etiology is not well known, but is influenced by cerebrovascular processes and other neurological problems, abnormalities of the detrusor muscle of bladder receptors, and obstructive and inflammatory processes of the lower urinary tract. Its diagnosis is clinical, and in the great majority of the cases it can be possible to establish its diagnosis and etiopathogenic orientation, without the need for complex diagnostic procedures. Currently, there are effective treatments for OAB, and we should decide the most appropriate for each elderly patient, based on their individual characteristics. Based on the main clinical practice guidelines, a progressive treatment is proposed, with the antimuscarinics being the most recommended drug treatment. Therefore, a group of very involved professionals in clinical practice for the elderly, and representing two scientific Societies (Spanish Society of Geriatrics and Gerontology [SEGG], and the Spanish Society of Primary Care Physicians [SEMERGEN]) developed this consensus document with the main objective of establishing practices and valid strategies, focused to simplify the management of this clinical entity in the elderly population, and especially to improve their quality of life.The recommendations presented in this consensus document are the result of a comprehensive review and critical discussion of articles, documents and clinical guidelines on OAB, both nationally and internationally. Are, where possible, levels of evidence and grades of recommendation are included.

Efficacy and safety of imidafenacin for overactive bladder in adult: a systematic review and meta-analysis

We carried out a systematic review and meta-analysis to assess the efficacy and safety of imidafenacin for treating overactive bladder in adult. A literature review was performed to identify all published randomized placebo-controlled trials of imidafenacin for the treatment of OAB. The search included the following databases: MEDLINE, EMBASE. The reference lists of retrieved studies were also investigated. Five publications involving a total of 1,428 patients were used in the analysis, which compared imidafenacin with propiverine and solifenacin. We found that imidafenacin was effective in treating OAB in our meta-analysis, which was similar to propiverine in its efficacy. The mean number of UI per week (the standardized mean difference (SMD) = 1.23, 95% CI -0.19 to 2.65, p = 0.09), the mean number of urgency episodes per day (SMD = 0.26, 95% CI -0.11 to 0.63, p = 0.17), the mean number of micturitions per day (SMD = 0.01, 95% CI -0.30 to 0.31, p = 0.96), and the mean urine volume (ml) per micturition (SMD = -13.04, 95% CI -20.45 to -5.62, p = 0.0006) indicated that imidafenacin was similar to propiverine in its efficacy. Mean OABSS (SMD = 0.48, 95% CI -0.08 to 1.03, p = 0.09) indicated that imidafenacin was also similar to solifenacin in its efficacy. Besides, imidafenacin was better tolerated than propiverine in the safety, indicated by dry mouth (OR 0.73, 95% CI 0.54-0.98, p = 0.04) and any adverse events (OR 0.63, 95% CI 0.46-0.88, p = 0.006). Moreover, imidafenacin was also better tolerated than solifenacin in the safety, indicated by constipation (OR 0.21, 95% CI 0.08-0.53, p = 0.001) and any adverse events (OR 0.33, 95% CI 0.15-0.71, p = 0.004). This meta-analysis indicates that imidafenacin was similar to propiverine or solifenacin in its efficacy for OAB and was better tolerated than propiverine or solifenacin in the safety for OAB. We conclude that imidafenacin is preferable to propiverine or solifenacin from a perspective of safety.

Acupuncture for adults with overactive bladder: a systematic review protocol

IntroductionOveractive bladder (OAB) is a symptom syndrome defined by the International Continence Society (ICS) as ‘the presence of urinary urgency (both daytime and nighttime), usually accompanied by increased frequency and...

Overactive bladder syndrome pharmacotherapy: future treatment options.

Overactive bladder syndrome (OAB) is a lifestyle disease and its incidence increases with age. Although it is not a life-threatening disease, it is known to have a significant impact on the quality of life. The first-choice pharmacological treatment of OAB is antimuscarinics. However, their limited clinical effectiveness and unsatisfactory tolerance profile, combined with the advancement of knowledge on the aetiopathogenesis of the disease, have inspired research on new pharmacotherapy options for OAB. Basic research has provided foundations for the development of new OAB treatments, which seem very promising and can be applied in clinical practice. The mechanisms of the studied compounds are based on their effect on certain receptors and neurotransmitters that contribute to regulating the micturition reflex. These compounds are not only more receptor-specific as compared to currently used drugs, but also some of them are organ-specific. Some of such compounds have already passed the proof-of-concept stage of development and have the therapeutic potential to determine the future of OAB pharmacotherapy. This review focuses on the mechanisms of substances that are now undergoing pre-clinical and clinical tests and their effects on the micturition cycle, while also identifying opportunities for using them with specific groups of patients. Due to the fact that OAB is a disease of symptoms and its aetiopathogenesis is complex, it seems that modern treatment methods should be tailor-made and based on the pathophysiological mechanisms that induce disease symptoms, rather than only treating the symptoms by inhibiting the contractility of the urinary bladder.

Inhibition of porcine detrusor contractility by the flavonoid fraction of Bryophyllum pinnatum – a potential phytotherapeutic drug for the treatment of the overactive bladder syndrome

Aims: To determine if the phytotherapeutic agent, Bryophyllum pinnatum, could serve as an alternative drug for the overactive bladder syndrome, and to characterise the fraction responsible for the inhibition of detrusor contractility.Methods: Fractions were prepared from the MeOH extract of B. pinnatum and further analysed by HPLC-PDA-MS. Detrusor muscle strips were prepared from porcine bladders and the electrically induced muscle contractility measured by organ bath. The effect of B. pinnatum leaf press juice (2.5–10%), a flavonoid fraction (0.1–1 mg/ml), and a bufadienolide fraction (0.1–40 μg/ml) on detrusor contractility was assessed and compared with controls (polar fraction (0.5–5 mg/ml) and oxybutynin (10−8–10−6 M)).Results: The press juice, at a concentration of 10% led to a reduction of detrusor contractility. Bladder strips treated with the flavonoid fraction showed a significant reduction of the contractility to 21.3 ± 5.2% (1 mg/ml) while the bufadienolide fraction had no inhibitory effect in the investigated concentrations. The polar fraction showed a reduction of the contractility in a pH-dependent fashion. At 10−6 M concentration oxybutynin reduced the detrusor contractility to 21.9 ± 4.7%.Conclusions: The flavonoid fraction of Bryophyllum pinnatum reduces the porcine detrusor contractility in a dose- and time-dependent manner. Fractions from B. pinnatum may be a new pharmacological approach for the treatment of OAB.

Does patient education increase antimuscarinic treatment persistence in overactive bladder syndrome?

ABSTRACTOveractive bladder syndrome (OAB) is a chronic condition that requires long‐term management. Patient education may have role in decreasing the unfavourable effects of long‐term treatment of OAB. The aim of the study was to evaluate the effect of detailed patient education on the patients' persistence with antimuscarinic treatment for OAB. A total of 140 patients with the diagnosis of OAB were included in this study. Patients were randomly divided into two groups. Patients in Group 1 were given information by the same urology doctor about the disease and treatment. Patients in Group 2 were given information by a urology nurse. Patients were recalled in the first, third and sixth months of treatment. The treatment persistency was evaluated in the whole study population and between the groups. The persistency rates of the whole group were 88·6% in the first month, 65·7% in the third month and 45·7% in the sixth month. At the end of the sixth month, 42·8% of males and 47·1% of females were taking antimuscarinics (p = 0·580). The persistence rate of Groups 1 and 2 were 82·8 and 94·3% at the first month. (p = 0·034). It decreased to 31·4% in the first and 60% in the second group at the sixth month (p = 0·001). The persistence rate of antimuscarinic treatment is low. Patient education is simple and effective way of increasing persistence. Clinicians must pay attention to inform their patients about the disease and possible side effects of treatment. An educated health provider may be very helpful in educating patients for OAB.

PRM236 - Novel Indirect Comparison Methodology for Estimating Time-Dependent Response To Antimuscarinics for the Treatment of Oab

Common indirect treatment comparison (ITC) methodology in overactive bladder involves combining absolute reduction in urge urinary incontinence (UUI) episodes at study endpoint (e. g., week 12) to estimate the overall treatment effect. Trials with differing endpoints must assume equivalence to be included in the network. Further, analyses of endpoint data are not sufficient to predict efficacy at intermediate time points (e. g. 4 or 6 weeks). We developed and tested an alternate methodology to utilize available intermediate time points into an ITC of published studies of fesoterodine and tolterodine. Study-level mean UUI reduction over time can be represented as the percent reduction from baseline, which can be modeled as a monotonically-increasing function with a theoretical maximum of 100%. This function is expressed with two parameters: %red = bi*time/ (ci + time), where bi is the maximum possible reduction for treatment i, and ci is the time required to reach half the maximum reduction. The inverse %red is a linear function of 1/time that can be used within a Bayesian ITC framework to generate a placebo-adjusted indirect comparison of efficacy. The endpoint results obtained from the alternate methodology were comparable to those obtained from an endpoint ITC. This novel methodology has the additional advantage of utilizing all available time point data within a single analysis, which can then be used to generate efficacy estimates at intermediate time points, which may be utilized within economic models. Limitations include unavailability of uncertainty estimates of the %red variable and difficulty of estimating combinations of parameters within functional constraints. Finally, our alternate methodology may be used for any longitudinal data exhibiting a monotonic increase or decrease and may be expanded to include a network with multiple treatments.

Pharmacological management of overactive bladder in women

Overactive bladder syndrome (OAB) is a chronic long-term condition whose frequency increases with age. Previous articles have shown that OAB is a prevalent condition, with 16.6% of adults over 40 years of age reporting symptoms ( Milson et al, 2001 ). This article aims to provide an overview of the National Institute for Health and Care Excellence (NICE) guidelines CG171 for the management of female urinary incontinence ( NICE, 2013 ). The guidance includes revised recommendations for the pharmacological treatment of OAB and new treatment pathways.

The efficacy and safety of onabotulinumtoxinA in treating idiopathic OAB: A systematic review and meta‐analysis

We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating idiopathic OAB. A literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of idiopathic OAB. The search included the following databases: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Eight publications involving a total of 1,320 patients were used in the analysis, including six RCTs that compared onabotulinumtoxinA with placebo. OnabotulinumtoxinA significantly decreased the mean number of urinary incontinence (UI) per day -2.77 versus -1.01 (the standardized mean difference (SMD) = -1.68, 95% CI = -2.06 to -1.31, P < 0.00001); the mean number of micturitions per day -1.61 versus -0.87 (SMD = -1.82, 95% CI = -2.61 to -1.02, P < 0.00001); maximum cystometric capacity (MCC) 91.39 versus 32.32 (SMD = 63.82, 95% CI = 38.14 to 89.50, P < 0.00001) and volume voided 44.29 versus 7.36 (SMD = 33.05, 95% CI = 22.45 to 43.66, P < 0.00001) versus placebo and 29.20% versus 7.95% of patients became incontinence-free (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 3.11 to 7.70, P < 0.00001). Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with complications resulting from postvoid residuals (PVR; P < 0.00001), urinary tract infections (UTI; P < 0.00001) and clean intermittent catheterization (CIC; P < 0.00001). This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for idiopathic overactive bladder symptoms with side effects primarily localized to urinary tract.

Overactive bladder symptom score to evaluate efficacy of solifenacin for the treatment of overactive bladder symptoms

Background Overactive bladder (OAB) is a series of symptoms with high prevalence in elderly people. This study was conducted using the overactive bladder symptom score (OABSS) to evaluate the efficacy of solifenacin succinate for the treatment of OAB. Methods This was a prospective, multicenter, single-arm, 12-week study that enrolled 241 OAB patients. The patients received 5-10 mg/day solifenacin. Changes in OABSS, symptoms from voiding diary, perception of bladder condition (PPBC) score, international prostate symptom score (IPSS) and quality of life (QOL) were evaluated at weeks 0, 4, and 12. The relationship between OABSS and PPBC score or parameters of voiding diary was also evaluated. Results At baseline, the mean OABSS for all patients was 9.41±2.40, and was reduced significantly at week 12 (-3.76 points; 61.21%, P &lt;0.0001). The OABSS subscore, PPBC score, IPSS, and QOL were also significantly reduced during the study (P &lt;0.0001). The overall incidence of adverse events was 19.91% (44 cases). The gastrointestinal system was the most commonly affected (11.31%). Around 5.88% of the cases had adverse events related to the genitourinary system. There was a strong correlation between OABSS and urinary symptoms that was recorded in the 3-day voiding dairy. Conclusions We showed that solifenacin was clinically effective for relieving OAB symptoms, considering the balance between efficacy, patients' well-being, and tolerability. OABSS integrates four OAB symptoms into a single score and can be a useful tool for research and clinical practice.

Efficacy and tolerability of solifenacin in men with overactive bladder: results of an observational study

To evaluate the efficacy and safety of solifenacin for the treatment of OAB in men. This prospective observational study, reflective of actual practice patterns, was conducted in men older than 18 years who were prescribed solifenacin for the treatment of OAB symptoms. Men with suspected bladder outlet obstruction were excluded. The primary efficacy measure was change in OAB symptoms after 12 weeks of solifenacin. Also assessed were changes in severity of urinary urgency, IPSS, quality of life, cognitive function, and adverse events. Data were analyzed using descriptive methods. A total of 799 men recruited at 251 centers, average age 67 years (range 27-92), received solifenacin 5 mg or 10 mg/day. Mean episodes of urinary urgency, frequency, and nocturia decreased by 4.4, 3.6, and 1.4 episodes/24 h, respectively. As per IPSS, severe urinary symptoms were reported by 20.4 % at baseline versus by 2.3 % at week 12. Both voiding and storage symptoms showed improvement. Patient-reported general health condition was excellent/good for 39 % at baseline increasing to 76 % at week 12. Adverse event rate was 5.5 %, and discontinuation of solifenacin due to an event was 1.6 %. No change in post-void residual urine volume was experienced in 80%, while an increase of ≥50 mL was observed in 2.2 %; no cases of acute urinary retention occurred. Baseline mean MMSE was 27.5 points versus 27.9 points at week 12. Solifenacin reduced all OAB symptoms, was well tolerated, and had no apparent effect on post-void residual urine volume. Cognitive function was unaltered in this population of older men with OAB.

Correlation of the Overactive Bladder Symptom Score, and the Voiding Diary and Urodynamic Parameters in Patients with Overactive Bladder Syndrome.

To investigate correlations between the overactive bladder symptom score (OABSS), the voiding diary, and urodynamic parameters in women with overactive bladder syndrome (OAB). A data analysis was performed on 164 women who presented with OAB between January 2006 and December 2011. All patients completed a 3-day voiding diary, OABSS (frequency [Q-F], nocturia [Q-N], urgency [Q-U], urgency incontinence [Q-UI]), and a urodynamic study. The relationships of the OABSS, voiding diary variables, and urodynamic parameters, such as detrusor overactivity (DO) and maximal cystometric capacity (MCC), were analyzed. We used univariate and multivariate regression analysis to compare the bladder diary and OABSS. Detrusor overactivity and other variables were compared using logistic regression analysis. The 24-h frequency, voided volume, and presence of urgency in the voiding diary were 9.8 ± 3.2 events/day, 176.6 ± 5.8 mL, and 70.7%. The 24-h frequency and the voided volume recorded were significantly associated with Q-F (P < 0.001, P < 0.001) and Q-N (P = 0.008, P = 0.005). The presence of urgency recorded was associated with Q-U in multivariate analysis (P = 0.012). The predictive factors related to DO was Q-U in multivariate analysis. The MCC was found to correlate with the voided volume, urgency episode, Q-F. The OABSS correlate well with the voiding diary and urodynamic parameters and could be a useful tool to diagnose OAB when there is an absence of voiding diary and to later monitor OAB symptoms and treatment interventions.

Long-Term Patterns of Use and Treatment Failure With Anticholinergic Agents for Overactive Bladder

BackgroundOveractive bladder (OAB) involves a complex set of symptoms with a lifetime prevalence of any symptom in ~30% of women and 20% of men. Anticholinergic agents are associated with poor medication persistence in OAB treatment. ObjectiveThis study evaluated the long-term patterns of use and treatment failure in patients prescribed anticholinergic agents for OAB. MethodsThis was a nonexperimental, retrospective cohort study. Medical, pharmacy, and eligibility data from the IMS LifeLink Health Plans Claims Database were used. Men and women aged ≥18 years were eligible for inclusion with an International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis of OAB in any field during the patient study period from January 2005 to June 2010. First documentation of a prescription filled between July 2005 and June 2008 for an anticholinergic agent was defined as the index prescription. Other inclusion criteria were: ≥1 pharmacy claim for an anticholinergic drug between July 2005 and June 2008; continuous enrollment 6 months before the index date, during which no anticholinergic drugs were filled; and 24 months of follow-up from the index prescription. Study outcomes were treatment failure, discontinuation, switch, reinitiation, and adherence. Treatment failure was defined as having a treatment discontinuation (ie, treatment gap of ≥45 days) or switching anticholinergic therapy. ResultsThe analytic cohort comprised 103,250 patients with a mean age of 58.7 years. A majority were female (73%) and privately insured (75%). The vast majority of patients (91.7%) failed to meet their treatment goals with their index anticholinergic agent over the 24-month follow-up period. Of these, 5.8% switched, 51.3% permanently discontinued all anticholinergic agents, and 34.6% reinitiated treatment sometime after 45 days. The mean (SD) time to treatment failure was 159 (216.0) days, with a mean of 1.3 (0.5) unique anticholinergic agents per patient. Forty-eight percent of patients demonstrated appropriate adherence as determined by a medication possession ratio ≥80%. ConclusionsThis study provides real-world data on treatment patterns over 2 years in a large cohort of patients diagnosed with OAB. Despite the potential for better adherence with some anticholinergic agents, these analyses suggest that such benefits have not yet been realized, and many patients end up without effective pharmacotherapy. Thus, there is a need for new therapies and strategies to increase persistence and adherence to improve outcomes in OAB.

Mirabegron: new treatment for OAB with fewer side‐effects

AbstractMirabegron (Betmiga) is a new class of drug for the treatment of overactive bladder. In our New products review, Steve Chaplin presents the clinical data relating to its efficacy and adverse events, and Professor Chapple discusses its place in treatment compared with anticholinergics.

Implementing hospital pharmacy practice changes

Accountability, bedside discharge counseling, and the Pharmacy Practice Model Initiative (PPMI) were just a few topics spotlighted at the 2012 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exposition.

Mirabegron use in the treatment of overactive bladder symptoms

AbstractBeta‐3 adrenoreceptors have been proposed as a target in the treatment of OAB due to their role in the mediation of bladder smooth muscle relaxation. Mirabegron is an oral medication that selectively targets beta‐3 adrenoreceptors and has been shown to reduce rhythmic abnormal detrusor contractions in animal models. In this Drug profile the authors present the clinical data relating to its efficacy and adverse effects and discuss its potential place in the treatment of OAB. Copyright © 2013 John Wiley &amp; Sons, Ltd.