Efficacy and safety of combinations of mirabegron and solifenacin in patients with overactive bladder: a systematic review and meta-analysis

Purpose: To investigate therapeutic efficacy enhancement capabilities of solifenacin and mirabegron combination in comparison to solifenacin monotherapy along with investigating the safety and tolerability of this combination. Methods: We searched electronic databases including EMBASE, MEDLINE, and EBM Reviews to identify studies that explored the outcomes of combination therapy of solifenacin and mirabegron in overactive bladder (OAB). The meta-analysis was performed by Review Manager 5.3 software. Results: In terms of efficacy, the results demonstrated that combination group presented significantly more mean volume voided (MVV) per micturition (MD=11.23; 95% CI: 7.21 to 15.25; P < 0.00001), less episodes of urgency incontinence (UI) (MD=-0.99; 95% CI: -1.17 to -0.80; P < 0.00001), less micturitions (MD=-0.45; 95% CI: -0.66 to -0.25; P < 0.0001), less urgency episodes (MD=-0.56; 95% CI: -0.83 to-0.29; P < 0.0001), lower Patient Perception of Bladder Condition (PPBC) scores (MD=-0.49; 95% CI: -0.51 to -0.47; P < 0.00001), and more zero-incontinence (OR=1.44; 95% CI: 1.24 to 1.67; P < 0.00001), which overtly improved the total health-related quality of life (HRQoL) scores (MD=5.39; 95% CI: 3.38 to 7.41; P < 0.00001) for OAB patients. As for safety, there was no significant difference between the two groups in terms of treatment-emergent adverse events (TEAEs), such as dry mouth, urinary tract infection (UTI), urinary retention, and QT prolongation in electrocardiogram (ECG). Conclusions: Combination therapy of solifenacin and mirabegron provides satisfactory therapeutic effect without increasing the risk of side effects, which undoubtedly improves quality of life of OAB patients. Combining mirabegron 50 mg with solifenacin 5 mg is a recommended dose due to the balance achieved between efficacy and acceptable tolerability.