- Design
- Systematic review and Bayesian network meta-analysis
- Population
- 18 trials of men on alpha-blockers with persistent storage symptoms
- Primary outcome
- Micturitions and urgency episodes per 24 hours
- Effect
- Vibegron vs control −0.81 voids/day (−1.31 to −0.38); vs mirabegron −0.35 (−1.05 to 0.26)
This Bayesian network meta-analysis, published in World Journal of Urology on 28 September, included 18 trials of add-on treatments for men with benign prostatic enlargement who still had overactive bladder symptoms despite an alpha-blocker.
Against control, vibegron reduced voids by about 0.8 a day and urgency episodes by about 1 a day; mirabegron reduced voids by about 0.5 a day. Indirect comparisons between vibegron and mirabegron were inconclusive, as were adverse events. Confidence was moderate for vibegron against control, and low for the head-to-head and safety estimates. The vibegron evidence came from only two trials.
Beta-3 agonists are an option for men whose storage symptoms persist on an alpha-blocker. This analysis does not support choosing one beta-3 agonist over another on efficacy.
- Consider a beta-3 agonist for storage symptoms persisting on an alpha-blocker.
- Choose between vibegron and mirabegron on availability, cost and interactions; efficacy was not shown to differ.
- Check post-void residual before adding bladder-relaxing treatment.
- Review symptom benefit with a frequency-volume chart.
Why it matters
Marketing may claim one beta-3 agonist is better; the indirect evidence does not show it.
Don't overread it
The vibegron estimates rest on two trials, and head-to-head comparisons were indirect.
The statistics, in plain English
Credible intervals are the Bayesian equivalent of confidence intervals. For vibegron versus mirabegron they included zero, so the analysis could not show a difference, despite high posterior probabilities.
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