Abstract General Information

Title

LONG-TERM EFFICACY OF MIRABEGRON-ANTICHOLINERGIC COMBINATION IN PAEDIATRIC NEUROGENIC BLADDER

Introduction and objective

The Mirabegron-anticholinergic (MAC) combination has proven effective as a step-up strategy in managing paediatric neurogenic bladder following anticholinergic medication and botulinum toxin (BTX) therapy. This study assesses the long-term efficacy of MAC in children with neurogenic bladder.

Method

A retrospective chart review was conducted from 2015 to 2023, including consecutive paediatric patients receiving Mirabegron (25/50mg) with an anticholinergic agent (solifenacin 17, tolterodine 9, oxybutynin 7, trospium 1). The study cohort had a minimum of 2 years of urodynamic (UD) follow-up (2-7 years) and 3.5 years of symptomatic follow-up (2-7 years). All patients used CIC. Efficacy was determined from UD data, symptom reports, and adverse events (AEs) with upper tract status. Statistical analysis used median values, Wilcoxon signed-rank test, and Chi-square (p<0.05).

Results

The analysis included 31 children (median age at start: 8 years, range: 4-15 years; 12 females) with neurogenic bladder due to myelomeningocele (17), closed spinal dysraphism (11), or spinal cord injury/tumor (3). A minimum of 8 weeks post-MAC therapy, significant improvements were observed in bladder capacity, compliance, and maximum detrusor pressure, and these were sustained and further improved at final UD follow-up (median 33 months) in 22 patients (Table 1). However, 9 patients showed initial UD improvement at median 5 months (range: 2-48 months) but lost the effect by median 27 months (range: 16-69), with 4 non-adherent patients and 5 with lower initial compliance. Initial symptom improvement occurred in 27 patients, sustained for a median of 43 months (range: 23-85) in 19 patients. AEs were minimal (28/31 with no AEs; constipation, fatigue, and UTI reported in one patient each), and no significant changes in blood pressure or upper tract status were observed.

Conclusion

MAC combination effectively manages paediatric neurogenic bladder resistant to AC and BTX therapy. In 80% the UD and symptom effects are maintained for a significant period (median 33 and 43 months respectively) when commenced before sig loss of compliance. MAC presents a promising long-term treatment option for the paediatric neurogenic bladder.