Re: Urodynamic Evaluation of the Efficacy of Vibegron, a New Β3-Adrenergic Receptor Agonist, on Lower Urinary Tract Function in Children and Adolescents with Overactive Bladder.

Introduction Idiopathic overactive bladder (OAB) is defined as an urgency symptom with or without urge inconti-nence, which is not due to known neurological ab-normalities. Since children present with variable symptoms, pediatric nonneurogenic idiopathic OAB is a condition that is difficult to diagnose and treat. Although there are few reports on bladder function in pediatric patients compared to adult patients, it can be useful for diagnosis. Antimuscarinic therapy is the pharmacological mainstay of OAB manage-ment. However, antimuscarinic use is limited by side effects and Insufficient effects. Vibegron, a new drug with a different mechanism of action (53-adrenoreceptor agonist), was recently introduced for treating OAB in adults but has not been studied in the pediatric population. Objective This study aimed to determine the efficacy and tolerability of vibegron in children and adolescents with idiopathic OAB. Study design We conducted a retrospective study enrolling pedi-atric patients with OAB whose symptoms did not improve with behavioral therapy or pharmaceutical therapy. Efficacy and tolerability were assessed via a question, and patients underwent video-urodynamic testing before and during treatment with once-daily 50 mg vibegron. Statistical differences were evalu-ated using Wilcoxon matched-pairs signed-rank tests.Results Out of the 17 patients that were recruited, full study with two urodynamic studies were confirmed by 11 patients. OAB symptoms improved in 14 (82.4%) pa-tients, and 3 patients discontinued treatment because of ineffectiveness. No patients discontinued treatment because of intolerance to vibegron. The median (IQR) first desire to void (133 [82-185]-161 [123-227] mL), bladder capacity (158 [136-238]-204 [150-257] mL), and bladder compliance (18.1 [9.1-76.7]-34.0 [30.0-82.3] mL/cm H2O) improved significantly post treatment compared to before treatment. Detrusor overactivity disappeared in one of the eight patients with this condition. The pa-rameters of voiding function did not change signifi-cantly after the administration of vibegron. Discussion Treatment with vibegron significantly improved clinical and urodynamic parameters of pediatric OAB with no adverse effects. Little information is avail-able regarding the feasibility of switching drugs when patients discontinue prior pharmacological therapy because of insufficient efficacy or poor tolerability in children. Vibegron may be a promising OAB treatment option with a better balance of ef-ficacy and tolerability. Conclusions Vibegron is an alternative agent for pediatric pa-tients with idiopathic OAB for improving both sub-jective symptoms and lower urinary tract function. Future prospective randomized studies with larger sample sizes must be conducted to validate the re-sults of the present study.