Mirabegron in Overactive Bladder and Its Role in Exit Strategy After Botulinum Toxin Treatment in Children

Area of Science:

• Pediatric Urology
• Pharmacology
• Overactive Bladder Management

Background:

• Overactive bladder (OAB) in children presents significant management challenges.
• Therapy-resistant OAB often requires advanced treatment strategies.
• Mirabegron represents a novel therapeutic option for pediatric OAB.

Purpose of the Study:

• To evaluate the efficacy of Mirabegron in pediatric patients with therapy-resistant overactive bladder.
• To determine Mirabegron's role in OAB treatment algorithms, particularly after botulinum toxin A therapy.
• To assess outcomes of Mirabegron as a monotherapy or combination therapy for pediatric OAB.

Main Methods:

• Retrospective review of case notes for children treated with Mirabegron from July 2017 to February 2020.
• Analysis of patient demographics, OAB type (idiopathic or neuropathic), and prior treatment history.
• Evaluation of treatment response (complete, partial, or no response) and side effects.

Main Results:

• Forty-one children (mean age 12.6 years) received Mirabegron, with 35 having idiopathic OAB and 6 neuropathic OAB.
• 59% received Mirabegron after partial/no response to anticholinergics; 41% received it after botulinum toxin A (BtA).
• Overall, 76% of patients achieved a complete or partial response (14% complete, 41% partial). Side effects occurred in 17% of patients.

Conclusions:

• Mirabegron, alone or with anticholinergics, provides significant benefit (76% complete/partial response) for anticholinergic-resistant pediatric OAB.
• It serves as a crucial treatment escalation step following inadequate response to anticholinergics.
• Mirabegron is a valuable exit strategy for managing recurring symptoms post-botulinum toxin A therapy.