Are Beta 3 Adrenergic Agonists Now the Preferred Pharmacologic Management of Overactive Bladder?

Curr Urol Rep. 2020 Oct 22;21(12):49. doi: 10.1007/s11934-020-01003-z.


Purpose of the review: This paper discusses the recent evidence supporting beta 3 adrenergic agonists as the preferred pharmacological management of overactive bladder syndrome.

Recent findings: Mirabegron has a similar efficacy profile to first-line antimuscarinics with favorable adverse effects profile. Treatment of OAB with beta-3 adrenergic agonist should be favored in patients at higher risk of anticholinergic adverse events. The efficacy and tolerability of beta-3 adrenergic agonists are consistently reported in older OAB patients, whether used alone or with other antimuscarinics. Mirabegron is cost-effective in treating OAB unless the symptoms were severe or refractory. Combination therapy of mirabegron and other pharmacotherapy has proven to be efficient in controlling OAB symptoms without inducing serious add-on adverse effects. While beta-3 adrenergic agonists bear favorable advantages in OAB treatment, physicians should perform a thorough and careful pre-treatment planning to optimize treatment benefits and adherence.

Keywords: B3 adrenergic agonists; Combination therapy; Efficacy; Mirabegron; Overactive bladder; Vibegron.

Publication types

  • Review

MeSH terms

  • Acetanilides / economics
  • Acetanilides / therapeutic use*
  • Adrenergic alpha-1 Receptor Antagonists / therapeutic use
  • Adrenergic beta-3 Receptor Agonists / economics
  • Adrenergic beta-3 Receptor Agonists / therapeutic use*
  • Cholinergic Antagonists / adverse effects
  • Cholinergic Antagonists / therapeutic use
  • Cost-Benefit Analysis
  • Humans
  • Muscarinic Antagonists / adverse effects
  • Muscarinic Antagonists / therapeutic use
  • Phosphodiesterase Inhibitors / therapeutic use
  • Pyrimidinones
  • Pyrrolidines
  • Thiazoles / economics
  • Thiazoles / therapeutic use*
  • Treatment Outcome
  • Urinary Bladder, Overactive / drug therapy*
  • Urinary Bladder, Overactive / economics
  • Urological Agents / therapeutic use*


  • Acetanilides
  • Adrenergic alpha-1 Receptor Antagonists
  • Adrenergic beta-3 Receptor Agonists
  • Cholinergic Antagonists
  • Muscarinic Antagonists
  • N-(4-((5-(hydroxy(phenyl)methyl)pyrrolidin-2-yl)methyl)phenyl)-4-oxo-4,6,7,8-tetrahydropyrrolo(1,2-a)pyrimidine-6-carboxamide
  • Phosphodiesterase Inhibitors
  • Pyrimidinones
  • Pyrrolidines
  • Thiazoles
  • Urological Agents
  • mirabegron