What is the role of beta-adrenergic agonists in urinary incontinence treatment?

Updated: Jan 22, 2021
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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These agents relax beta-adrenergic receptors that are contained in smooth muscle, such as the bladder. Studies of terbutaline and clenbuterol have yielded mixed results. The role of these drugs as adjuncts to other pharmacologic therapies has not been explored.

Mirabegron (Myrbetriq), a beta-3 adrenergic receptor agonist, causes relaxation of the detrusor muscle and increases bladder capacity. It is indicated for overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency. A guideline from the American Urological Association recommends beta-3-adrenergic receptor agonists as second-line therapy in patients with an inadequate response to behavioral therapy. [74]

The agent 1-desamino-8-D-arginine vasopressin (DDAVP) has been used in children with nocturnal enuresis, with good results. The hormone causes water to be reabsorbed from the renal collecting system. Reduction in nighttime urine production may be beneficial in patients with detrusor overactivity and a significant degree of nocturia. Caution is needed when using this drug in elderly patients. Do not use in patients with significant heart failure or in children younger than 5 years (eg, water intoxication). 

Vibegron (Gemtesa) is another beta-3 adrenergic agonist that is indicated for adults with overactive bladder who have symptoms of urge urinary incontinence, urgency, and urinary frequency. Approval was based on the EMPOWUR phase 3 clinical trial, which compared vibegron with tolterodine and placebo. Of 1518 randomized patients, 90.4% completed the trial. At 12 weeks, micturition episodes decreased by an adjusted mean of 1.8 episodes per day for vibegron compared with 1.3 for placebo (P < 0.001) and 1.6 for tolterodine. Among incontinent patients, urge incontinence episodes decreased by an adjusted mean 2 episodes per day for vibegron compared with 1.4 for placebo (P < 0.0001) and 1.8 for tolterodine. [75]  

In a 52-week continuation study of EMPOWUR, vibegron demonstrated favorable long-term safety, tolerability, and efficacy. For this study, patients who had completed 12 weeks of once-daily vibegron 75 mg or tolterodine 4 mg extended release continued double-blind treatment, while patients who had completed 12 weeks of placebo were randomly assigned to receive double-blind vibegron or tolterodine. Of the 506 participants, 430 (85%) completed the study; only 12 (2.4%) discontinued owing to adverse events. Patients receiving vibegron maintained improvements in efficacy endpoints. [76]  

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