A network meta-analysis of five trials and 5,317 patients compared vibegron, mirabegron and tolterodine for overactive bladder — the everyday question of which agent to reach for first.
Vibegron ranked best for reducing urgency and urgency-incontinence episodes and for improving maximum voided volume, while mirabegron ranked best for reducing daytime urinary frequency and was least likely to raise blood pressure. Tolterodine, the antimuscarinic, carried the highest rates of dry mouth. Adverse-event definitions were inconsistent across trials, so tolerability rankings are softer than the efficacy ones.
In practice this supports matching the drug to the dominant complaint: a beta-3 agonist (vibegron or mirabegron) where urgency and incontinence dominate or anticholinergic burden is a concern, with mirabegron favoured when hypertension is not an issue and frequency is the main problem. It does not settle cost, contraindications or swallowing difficulties, which often decide the choice.
- Vibegron: best for urgency, urgency-incontinence and voided volume
- Mirabegron: best for daytime frequency and least likely to raise blood pressure
- Tolterodine: highest dry mouth — weigh anticholinergic burden, especially in older patients
- Match the agent to the dominant symptom; cost and contraindications still decide many cases
The statistics, in plain English
A network meta-analysis ranks drugs by combining direct and indirect comparisons, so it can order agents never tested head-to-head — but rankings are only as reliable as the five underlying trials. Because adverse-event definitions differed between studies, treat the efficacy ordering as firmer than the tolerability ordering.
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