Cardiovascular Safety of β3 -adrenoceptor Agonists for the Treatment of Patients with Overactive Bladder Syndrome

Abstract Context Mirabegron, the first β3 -adrenoceptor agonist in clinical practice, is approved for treatment of overactive bladder (OAB) syndrome symptoms. Because β3 -adrenoceptors are expressed in cardiovascular (CV) tissues, there are concerns that OAB treatment with β3 -adrenoceptor agonists may affect the heart and vasculature. Objective To provide a summary of CV effects of β3 -adrenoceptor agonists in clinical studies. Evidence acquisition A systematic literature search from inception until November 2014 was performed on studies in PubMed and Medline. Evidence synthesis Twenty papers, published between 1994 and 2014, were identified: mirabegron (16), solabegron (2), AK-677 (1), and BRL35135 (1). More detailed CV data from mirabegron studies were available in online regulatory documents filed with the US Food and Drug Administration and the UK National Institute for Health and Care Excellence. Conclusions The CV safety of mirabegron appears to be acceptable at therapeutic doses and comparable with that of antimuscarinic agents, currently first-line therapy for OAB. Patient summary In this review we looked at the cardiovascular (CV) effects of β3 -adrenoceptor agonists used for the treatment of overactive bladder (OAB). The CV safety of mirabegron (the only clinically approved β3 -adrenoceptor agonist) appears to be acceptable at therapeutic doses and comparable with that of antimuscarinic agents, the current first-line therapy for OAB.