From the Guidelines
The first-line choice for urgent incontinence should be behavioral therapies, such as bladder training, bladder control strategies, pelvic floor muscle training, and fluid management, as they are effective in reducing symptom levels and have a low risk of adverse effects. According to the most recent and highest quality study 1, behavioral therapies are a group of risk-free, tailor-made therapies that improve individual symptoms by changing patient behavior or the patient’s environment. The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) guideline 1 recommends offering behavioral therapies as first-line therapy to all patients with overactive bladder (OAB).
Some key points to consider when implementing behavioral therapies include:
- Bladder training: This involves gradually increasing the time between voiding to help the patient learn to hold urine for longer periods.
- Pelvic floor muscle training: This involves exercises to strengthen the muscles that support the bladder and urethra.
- Fluid management: This involves managing fluid intake to reduce the amount of urine produced and prevent urgency.
- Timed voiding: This involves voiding at regular intervals to prevent urgency and incontinence.
It is essential to note that while pharmacologic therapies, such as antimuscarinics and beta-3 adrenergic agonists, may be effective in managing urgency urinary incontinence, they should only be considered if behavioral therapies are unsuccessful, due to their potential adverse effects 2, 3.
In terms of specific medications, the choice of pharmacologic agent should be based on tolerability, adverse effect profile, ease of use, and cost of medication 2. However, behavioral therapies should always be the first-line choice for urgent incontinence, as they are effective, have a low risk of adverse effects, and can be tailored to the individual patient's needs.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adult Overactive Bladder (OAB) Mirabegron Monotherapy Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.
The first line choice for urgent incontinence is not explicitly stated in the provided drug labels. However, mirabegron is indicated for the treatment of Overactive Bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency 4, 5, 6.
- Key points:
- Mirabegron is used to treat OAB symptoms, including urge urinary incontinence.
- The drug labels do not explicitly state that mirabegron is the first line choice for urgent incontinence.
- Mirabegron has been shown to be effective in treating OAB symptoms, including urge urinary incontinence, in clinical trials 4, 6.
From the Research
First Line Choice for Urgent Incontinence
- The first line choice for urgent incontinence, also known as urgency urinary incontinence (UUI), typically involves behavioral modifications and pharmacologic therapies, primarily antimuscarinic agents 7.
- Antimuscarinic agents are moderately efficacious but have troublesome side-effects, which can result in poor compliance and persistence with therapy 7.
- Other pharmacologic options for UUI include β3-adrenergic agents such as mirabegron, which has been introduced in recent years as an alternative to antimuscarinic agents 8.
- The choice of pharmacologic agent may depend on the individual patient's symptoms and medical history, as well as the potential side effects of the medication 9, 10.
- For example, oxybutynin is often recommended in guidelines, but it has been associated with a higher incidence of adverse drug effects, particularly cognitive impairment in older adults 10.
- In contrast, tolterodine has been shown to have greater efficacy and tolerability compared to oxybutynin, making it a potentially better option for some patients 9.
- Ultimately, the choice of first line treatment for urgent incontinence should be individualized and based on a thorough assessment of the patient's symptoms and medical history 11, 8.