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Matsuda K, Teruya K, Uemura O. Urodynamic effect of vibegron on neurogenic lower urinary tract dysfunction in individuals with spinal cord injury: A retrospective study. Spinal Cord 2022; 60:716-721. [PMID: 35177800 DOI: 10.1038/s41393-022-00766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A Retrospective study. OBJECTIVES To investigate the effects of vibegron on urodynamic parameters of individuals with spinal cord injury (SCI). SETTING The National Hospital Organization, Murayama Medical Center, Japan. METHODS We retrospectively analyzed the urodynamic parameters of 31 individuals with SCI within one year after injury, who were diagnosed with neurogenic lower urinary tract dysfunction (NLUTD) according to a urodynamic study (UDS), and prescribed vibegron between December 2018 and December 2020. Treatment criteria were as follows: cystometric capacity of <200 mL, bladder compliance of <20 mL/cmH2O, and/or presence of detrusor overactivity in the first UDS. We compared urodynamic data before and after vibegron treatment. RESULTS Vibegron administration increased the maximum cystometric capacity (MCC) (median, from 185.0 to 340.0 mL, P = 0.001), bladder compliance (median, from 8.3 to 20.0 mL/cmH2O, P < 0.001). CONCLUSION Vibegron therapy improved the bladder capacity and bladder compliance of individuals with NLUTD and SCI.
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Affiliation(s)
- Kyohei Matsuda
- Department of Rehabilitation Medicine, Faculty of Medicine, Kyorin University, Tokyo, Japan.,National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - Koji Teruya
- Department of Health and welfare, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - Osamu Uemura
- National Hospital Organization Murayama Medical Center, Tokyo, Japan.
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Zhang D, Sun F, Yao H, Bao X, Wang D, Cui Y, Wu J. The Efficacy and Safety of Mirabegron for the Treatment of Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review and Meta-analysis. Front Pharmacol 2021; 12:756582. [PMID: 34867373 PMCID: PMC8636815 DOI: 10.3389/fphar.2021.756582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background and Objective: Over the past few years, mirabegron has been increasingly used as a therapeutic option for neurogenic lower urinary tract dysfunction. Here, we carried out a meta-analysis to investigate the efficacy and safety of mirabegron for the treatment of neurogenic lower urinary tract dysfunction. Methods: We used a range of databases to retrieve randomized controlled trials (RCTs) relating to mirabegron in patients with neurogenic lower urinary tract dysfunction: PubMed, Embase, and Cochrane Library; our strategy conformed to the PICOS (populations, interventions, comparators, outcomes, and study designs) strategy. Results: Our analyses involved four RCTs involving 245 patients. We found that mirabegron treatment resulted in a significant improvement in bladder compliance [mean difference (MD) = 19.53, 95% confidence interval (CI): 14.19 to 24.87, P < 0.00001], urinary incontinence episodes (MD = −0.78, 95% CI: −0.89 to −0.67, P < 0.00001) and Incontinence Quality of Life (I-QOL) (MD = 8.02, 95% CI: 3.20 to 12.84, P = 0.001). Significant differences were detected in terms of Patient Perception of Bladder Condition (PPBC) (MD = −0.54, 95% CI: −1.46 to 0.39, P = 0.26) and urinary urgency episodes (MD = −0.72, 95% CI: −3.1 to 1.66, P = 0.55). With regard to safety, there were no significant differences between mirabegron and control groups in terms of the incidence of drug-related adverse events [odds ratio (OR): 0.83, 95% CI: 0.43 to 1.59, P = 0.57], arrhythmias (OR: 1.27, 95% CI: 0.37 to 4.38, P = 0.70), hypertension (OR: 0.70, 95% CI: 0.13 to 3.82, P = 0.68), or post-voiding residual volume (MD: 1.62, 95% CI: −9.00 to 12.24, P = 0.77). Conclusion: Mirabegron is an efficacious and safe treatment for patients with neurogenic lower urinary tract dysfunction.
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Affiliation(s)
- Dongxu Zhang
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Fengze Sun
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Huibao Yao
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xingjun Bao
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Di Wang
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yuanshan Cui
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.,Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
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Krhut J, Wohlfahrt P, Pudich J, Kufová E, Borovička V, Bílková K, Sýkora R, Mokriš J, Cífková R, Zachoval R, Zvara P. Cardiovascular safety of mirabegron in individuals treated for spinal cord injury- or multiple sclerosis-induced neurogenic detrusor overactivity. Int Urol Nephrol 2021; 53:1089-1095. [PMID: 33417146 DOI: 10.1007/s11255-020-02774-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To analyze cardiovascular safety of mirabegron in patients with spinal cord injury (SCI)- and multiple sclerosis (MS)-induced neurogenic detrusor overactivity (NDO) in a prospective, randomized, double-blind, placebo-controlled study. METHODS Seventy-eight patients were enrolled into the study, and 66 of them were included into the final analysis. In 49 (74.2%), NDO developed due to suprasacral SCI, 17 (25.8%) suffered from NDO due to MS. Eleven patients were previously treated for hypertension and one for arrhythmia. All study participants received placebo for 2 weeks run-in period. Subsequently, eligible subjects were randomized for 4 weeks of active treatment with mirabegron 50 mg once daily (Group A; n = 32) or placebo (Group B; n = 34). Data from resting electrocardiography (ECG), 24-h ECG and blood pressure monitoring, and echocardiographic examination, were used for cardiovascular safety assessment. All reported variables were evaluated at time of randomization and at the end of the study. Longitudinal changes of variables within the groups and differences between the groups were assessed using nonparametric Kruskal-Wallis test, and p ≤ 0.05 was considered statistically significant. RESULTS No statistically significant longitudinal changes were found in safety variables, except for prolongation of QT interval in placebo group (p = 0.0328) recorded by resting ECG. No significant difference between the Groups A and B, in any of the variables, was observed. A single cardiovascular study drug-related adverse event was recorded in a patient with cervical SCI (3.13%). CONCLUSIONS Our results suggest that mirabegron can be safely used in the treatment of patients with SCI- and MS-induced NDO.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Tř. 17. listopadu 1790, 708 52, Ostrava, Czech Republic. .,Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic.
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention, 1st Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jiří Pudich
- Department of Cardiology, University Hospital, Ostrava, Czech Republic
| | - Eliška Kufová
- Department of Cardiology, University Hospital, Ostrava, Czech Republic
| | - Vladimír Borovička
- Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Karolína Bílková
- Spinal Cord Rehabilitation Unit, Rehabilitation Center, Kladruby, Czech Republic
| | - Radek Sýkora
- Department of Urology, University Hospital, Tř. 17. listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - Jan Mokriš
- Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Renata Cífková
- Center for Cardiovascular Prevention, 1st Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Roman Zachoval
- Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Peter Zvara
- Department of Clinical Research, Biomedical Laboratory and Research Unit of Urology, University of Southern Denmark, Odense, Denmark.,Department of Urology, Odense University Hospital, Odense, Denmark
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Kovacevic N, Lopes NN, Raffee S, Atiemo HO. Predicting Upper Urinary Tract Risk in the Neurogenic Bladder Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zimmermann G, Kieser M, Bathke AC. Sample size calculation and blinded recalculation for analysis of covariance models with multiple random covariates. J Biopharm Stat 2019; 30:143-159. [PMID: 31327284 DOI: 10.1080/10543406.2019.1632871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
When testing for superiority in a parallel-group setting with a continuous outcome, adjusting for covariates is usually recommended. For this purpose, the analysis of covariance is frequently used, and recently several exact and approximate sample size calculation procedures have been proposed. However, in case of multiple covariates, the planning might pose some practical challenges and pitfalls. Therefore, we propose a method, which allows for blinded re-estimation of the sample size during the course of the trial. Simulations confirm that the proposed method provides reliable results in many practically relevant situations, and applicability is illustrated by a real-life data example.
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Affiliation(s)
- Georg Zimmermann
- Department of Mathematics, Paris Lodron University, Salzburg, Austria.,Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Arne C Bathke
- Department of Mathematics, Paris Lodron University, Salzburg, Austria.,Department of Statistics, University of Kentucky, Lexington, KY, USA
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Krhut J, Borovička V, Bílková K, Sýkora R, Míka D, Mokriš J, Zachoval R. Efficacy and safety of mirabegron for the treatment of neurogenic detrusor overactivity-Prospective, randomized, double-blind, placebo-controlled study. Neurourol Urodyn 2018; 37:2226-2233. [PMID: 29603781 DOI: 10.1002/nau.23566] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/05/2018] [Indexed: 11/11/2022]
Abstract
AIMS To assess the efficacy and safety of mirabegron in the treatment of neurogenic detrusor overactivity. METHODS This prospective, multicenter, randomized, double-blind, placebo-controlled study was conducted in three tertiary centers, and included 78 patients suffering from spinal cord injury or multiple sclerosis. Patients were randomized for Mirabegron 50 mg (Group A) or placebo (Group B). Urodynamic parameters, the 24 h pad-weight test, and patient-reported outcomes were assessed. Safety assessments included monitoring the incidence and severity of adverse events. Changes in time and differences between groups were assessed with nonparametric Kruskal-Wallis one-way analysis of variance; P ≤ 0.05 was considered statistically significant. RESULTS In total, 66 patients were eligible for inclusion in the final analysis. There was a significant increase of volume at the first detrusor contraction (P = 0.00047) and an improvement in bladder compliance (P = 0.0041) in the mirabegron group compared with the placebo-treated group, whereas the increase in cystometric capacity did not reach statistical significance (P = 0.061). There was a clear tendency to reduced urine leakage (P = 0.056) in Group A. There were significant changes in all the patient-reported outcomes, favoring the mirabegron group. The incidence of drug-related adverse events was 3.13%. CONCLUSIONS Mirabegron (50 mg) improved both urodynamic variables and patient-reported outcomes in patients with NDO. The treatment was tolerated well.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | | | - Karolína Bílková
- Spinal Cord Rehabilitation Unit, Rehabilitation Center, Kladruby, Czech Republic
| | - Radek Sýkora
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - David Míka
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - Jan Mokriš
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
| | - Roman Zachoval
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
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Faccendini A, Vigani B, Rossi S, Sandri G, Bonferoni MC, Caramella CM, Ferrari F. Nanofiber Scaffolds as Drug Delivery Systems to Bridge Spinal Cord Injury. Pharmaceuticals (Basel) 2017; 10:ph10030063. [PMID: 28678209 PMCID: PMC5620607 DOI: 10.3390/ph10030063] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/13/2017] [Accepted: 07/01/2017] [Indexed: 12/21/2022] Open
Abstract
The complex pathophysiology of spinal cord injury (SCI) may explain the current lack of an effective therapeutic approach for the regeneration of damaged neuronal cells and the recovery of motor functions. A primary mechanical injury in the spinal cord triggers a cascade of secondary events, which are involved in SCI instauration and progression. The aim of the present review is to provide an overview of the therapeutic neuro-protective and neuro-regenerative approaches, which involve the use of nanofibers as local drug delivery systems. Drugs released by nanofibers aim at preventing the cascade of secondary damage (neuro-protection), whereas nanofibrous structures are intended to re-establish neuronal connectivity through axonal sprouting (neuro-regeneration) promotion, in order to achieve a rapid functional recovery of spinal cord.
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Affiliation(s)
- Angela Faccendini
- Department of Drug Sciences, University of Pavia, Viale Taramelli, 12, 27100 Pavia, Italy.
| | - Barbara Vigani
- Department of Drug Sciences, University of Pavia, Viale Taramelli, 12, 27100 Pavia, Italy.
| | - Silvia Rossi
- Department of Drug Sciences, University of Pavia, Viale Taramelli, 12, 27100 Pavia, Italy.
| | - Giuseppina Sandri
- Department of Drug Sciences, University of Pavia, Viale Taramelli, 12, 27100 Pavia, Italy.
| | | | | | - Franca Ferrari
- Department of Drug Sciences, University of Pavia, Viale Taramelli, 12, 27100 Pavia, Italy.
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