Re: Efficacy and Safety of Combination Pharmacotherapy for Patients with Overactive Bladder: A Rapid Evidence Assessment
Abstract
available at https://pubmed.ncbi.nlm.nih.gov/31416636/ Editorial Comment: This impressive group of authors conducted a literature search in June 2018, looking for studies reporting the efficacy and safety of a beta3-adrenoceptor agonist plus an antimuscarinic, and studies reporting similar details that combined 2 antimuscarinics. Drugs comprising the former combination consisted exclusively of mirabegron plus solifenacin in various dosages, and those comprising the latter type consisted of trospium plus solifenacin. What the 1388 VOIDING FUNCTION AND DYSFUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. authors report is what I think many providers have experienced at this point, which is combining mirabegron with the lower dose of solifenacin results in essentially the same or better efficacy vs the higher dose of solifenacin without the added side effects of an increasing dose of antimuscarinic. They recommend this for patients with overactive bladder who do not achieve adequate response to antimuscarinic therapy alone, and comment that this approach may also limit anticholinergic burden for the elderly. It is my opinion that one would likely find similar results with any future approved beta3-agonist and any other titratable antimuscarinic, although this remains to be documented. The authors also suggest that this concept…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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