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

Context: Mirabegron, the first beta(3)-adrenoceptor agonist in clinical practice, is approved for treatment of overactive bladder (OAB) syndrome symptoms. Because beta(3)-adrenoceptors are expressed in cardiovascular (CV) tissues, there are concerns that OAB treatment with beta(3)-adrenoceptor agonists may affect the heart and vasculature. Objective: To provide a summary of CV effects of beta(3)-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 beta(3)-adrenoceptor agonists used for the treatment of overactive bladder (OAB). The CV safety of mirabegron (the only clinically approved beta(3)-adrenoceptor agonist) appears to be acceptable at therapeutic doses and comparable with that of antimuscarinic agents, the current first-line therapy for OAB. (C) 2015 European Association of Urology. Published by Elsevier B.V.