Date of Award

Spring 2021

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Elizabeth Masten

Abstract

Introduction: Overactive bladder is a condition where the bladder muscles contract before the bladder is full, causing the urge to urinate. People with overactive bladder, or urge incontinence, have intense urges to urinate as a result of various disorders or injuries, including detrusor overactivity, neurologic disorder or spinal cord injury. The standard first- line medication for overactive bladder is solifenacin, and mirabegron serves as an alternative option. Solifenacin is an anticholinergic medication that is associated with a wide range of undesirable side effects. Therefore, this review analyzes the use of a combination of mirabegron and solifenacin, compared to monotherapy with solifenacin, for symptom management in patients suffering from moderate to severe overactive bladder.

Methods: A literature search was completed through PubMed, Academic Search Ultimate, and Google Scholar in November 2019. A total of seven articles consisting of randomized control trials were selected based on their publication date, intervention technique, outcome measurements, and sample population. The study design and results of these articles were then analyzed and compared.

Results: This literature review revealed evidence that the combination of mirabegron and solifenacin is efficacious and may be a superior option to others in controlling the symptoms of overactive bladder in adult patients. Six of the seven studies comparing the combination of mirabegron and solifenacin to monotherapy found statistically significant improvement in number of incontinence episodes and mean number of micturitions in 24 hours with combination therapy.

Discussion: Six of the seven studies observed a greater reduction in symptoms of overactive bladder when being treated with a combination of mirabegron and solifenacin when compared to monotherapy with solifenacin. These studies all noted a significant improvement in number of incontinence episodes and mean number of micturitions in 24 hours. The studies also observed minimal to no increase in adverse effects when using both mirabegron and solifenacin together for treatment. However, there have yet to be enough studies with a large population size and a long-term duration.

Conclusion: Solifenacin and mirabegron have both been prescribed for the treatment of overactive bladder, but there is little evidence that has been collected on the combination of solifenacin and mirabegron in combination. Six studies selected for this review found significant improvement of overactive bladder symptoms including number of incontinence episodes and mean number of micturitions in 24 hours, proving that this may be an effective treatment for patients who fail monotherapy treatment due to anticholinergic side effects or intolerance. Future research is warranted to further investigate the long-term effects of this treatment.

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Efficacy of the Combination of Mirabegron and Solifenacin Compared to Standard of Care of Monotherapy in Controlling Urinary Incontinence Symptoms in Adults Diagnosed with Overactive Bladder

Introduction: Overactive bladder is a condition where the bladder muscles contract before the bladder is full, causing the urge to urinate. People with overactive bladder, or urge incontinence, have intense urges to urinate as a result of various disorders or injuries, including detrusor overactivity, neurologic disorder or spinal cord injury. The standard first- line medication for overactive bladder is solifenacin, and mirabegron serves as an alternative option. Solifenacin is an anticholinergic medication that is associated with a wide range of undesirable side effects. Therefore, this review analyzes the use of a combination of mirabegron and solifenacin, compared to monotherapy with solifenacin, for symptom management in patients suffering from moderate to severe overactive bladder.

Methods: A literature search was completed through PubMed, Academic Search Ultimate, and Google Scholar in November 2019. A total of seven articles consisting of randomized control trials were selected based on their publication date, intervention technique, outcome measurements, and sample population. The study design and results of these articles were then analyzed and compared.

Results: This literature review revealed evidence that the combination of mirabegron and solifenacin is efficacious and may be a superior option to others in controlling the symptoms of overactive bladder in adult patients. Six of the seven studies comparing the combination of mirabegron and solifenacin to monotherapy found statistically significant improvement in number of incontinence episodes and mean number of micturitions in 24 hours with combination therapy.

Discussion: Six of the seven studies observed a greater reduction in symptoms of overactive bladder when being treated with a combination of mirabegron and solifenacin when compared to monotherapy with solifenacin. These studies all noted a significant improvement in number of incontinence episodes and mean number of micturitions in 24 hours. The studies also observed minimal to no increase in adverse effects when using both mirabegron and solifenacin together for treatment. However, there have yet to be enough studies with a large population size and a long-term duration.

Conclusion: Solifenacin and mirabegron have both been prescribed for the treatment of overactive bladder, but there is little evidence that has been collected on the combination of solifenacin and mirabegron in combination. Six studies selected for this review found significant improvement of overactive bladder symptoms including number of incontinence episodes and mean number of micturitions in 24 hours, proving that this may be an effective treatment for patients who fail monotherapy treatment due to anticholinergic side effects or intolerance. Future research is warranted to further investigate the long-term effects of this treatment.