FDA Approves Supplemental New Drug Application for Myrbetriq (mirabegron) for Use in Combination with Solifenacin Succinate for the Treatment of Overactive Bladder Symptoms

In continuation of my update on mirabegron

Astellas Pharma Inc. announced  that the U.S. Food and Drug Administration (FDA) has approved a supplemental New Drug Application (sNDA) for the use of mirabegron in combination with the muscarinic antagonist solifenacin succinate for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency and urinary frequency.

In the United States, mirabegron and solifenacin succinate are marketed as Myrbetriq® and VESIcare®, respectively. Each is approved by the FDA as a monotherapy for OAB. 

"OAB patients may have symptoms that are not fully managed with their current treatment," said Carol Schermer, M.D., M.P.H., senior medical director, urology, Astellas. "With the FDA approval of Myrbetriq in combination with solifenacin succinate, Astellas is able to offer an additional treatment option to individuals living with symptoms of OAB."

The sNDA submission was based on data from the global Phase 3 SYNERGY I, SYNERGY II and BESIDE studies. These studies evaluated combination therapy with mirabegron and solifenacin succinate compared with each drug as monotherapy or placebo.

Drug stimulates brown fat, boosts metabolism

We know that, Mirabegron (formerly YM-178, trade name Myrbetriq, Betmiga in Spain) is a drug for the treatment of overactive bladder. It was developed by Astellas Pharma and was approved in the United States in July 2012.  Mirabegron activates the β3 adrenergic receptor in the detrusor muscle in the bladder, which leads to muscle relaxation and an increase in bladder capacity. 

Previous studies have found that brown fat can be coaxed into action by activating the β3-adrenergic receptor, which is expressed on the surfaces of brown and white fat cells, as well as on cells of the urinary bladder and other tissues. With these findings in mind, investigators wondered whether mirabegron, a drug that targets the β3-adrenergic receptor and was recently approved to treat overactive bladder, might help keep people's weight in check.

In all 12 men enrolled in the study, 200 milligrams of mirabegron led to higher brown fat metabolic activity, and at its peak level in the blood it increased the men's resting metabolic rate by 203 calories per day. While the dose was higher than the 50 milligram dose approved for overactive bladder, the treatment was well tolerated. All of the study participants were young, healthy individuals who had not previously taken mirabegron.

"Brown adipose tissue, or brown fat, produces β3-adrenergic receptor at levels higher than nearly every other organ in the body. We showed that a one-time dose of the drug mirabegron stimulates human brown adipose tissue so that it consumes glucose and burns calories," said lead author Dr. Aaron Cypess, who conducted the work at Joslin Diabetes Center and Beth Israel Deaconess Medical Center, affiliates of Harvard Medical School, and is now at the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.

The findings suggest that drugs that activate the β3-adrenergic receptor may be a promising treatment for obesity. "Prior to our work, the only known way to activate human brown adipose tissue was through cold exposure. While inexpensive, this approach is generally not well tolerated over the long term, and there is significant variability in people's responses," said Dr. Cypess. "In addition, once the cold exposure is removed, the effect usually turns off rather quickly."

Drug stimulates brown fat, boosts metabolism