Oral Medications As the Second Line of treatment for OAB

Continuing our mission to break the stigma and shift cultural norms surrounding OAB, the focus of this article is on the second line of treatment – oral medications. There are two medication groups available for treating OAB: anticholinergic and beta-3 adrenergic agonists. However, these medications can produce many side effects such as dry mouth, constipation, and increased blood sugar levels, causing many patients to withdraw from their treatment.  


Did you know that anticholinergics are used for various indications such as COPD, Morbus Parkinson, or Depressions? But how do these little pills work against OAB? When binding to a cholinergic receptor, like a key to its lock, oral anticholinergics have an inhibitory effect. In the case of the bladder, this decreases muscle contractility, leading to less micturition and, therefore, reducing the patient’s suffering. Unfortunately, these receptors are distributed all over our body and can therefore also cause increased heart rate, constipation, dry mouth, and disorientation. This can be dangerous, especially for older adults, since these side effects increase the risk of falling. Despite a proven positive impact of oral anticholinergics for the OAB treatment, the side effects list is weighed too long and causes high discontinuation rates in many women.


What about the beta-agonists? For a long time, anticholinergics like Solifenacin were the only oral treatment option for OAB. But β-3 adrenergic (AR) agonists such as Mirabegron received FDA market approval in 2012 only! Do you know how do they work? Mirabegron selectively acts on the β-3 AR receptors in the bladder, causing relaxation of the bladder smooth muscle. It decreases the frequency of bladder contractions, thereby decreasing the number of urinary voids. However, side effects of β-3 AR agonists include headache, dizziness, increased heart rate, constipation/diarrhea, and elevated blood pressure. Recent clinical studies suggest that a combined Solifenacin-Mirabegron therapy could improve filling volume, micturition frequency, and urgency with slightly fewer side effects compared to monotherapy. As we can see, there are two options but no perfect solution for OAB patients. Well, just not yet…


To sum up, there are two classes of oral medications available for the treatment of OAB. Both have limitations in terms of adverse effects. These side effects limit their use for patients and lead to their discontinuation. Retrospective data analysis addressing adherence to therapy shows a treatment discontinuation rate of 71.8% and 67% over a 12-month follow-up period for anticholinergics and β-3 adrenergic (AR) agonists respectively. In the absence of effective and safe treatment, patients frequently have to live with chronic disease. In our survey regarding a new treatment option for OAB, most surveyed Gynecologists and Urologists (21 out of 25!) underscored the requirement to have a new treatment approach.


About Inura Medical

Inura Medical AG (“Inura”) is a Swiss start-up company with a clear vision to make a difference in women’s health. Inura’s product is an innovative, first-of-a-kind “urethral ovulum” that utilizes a novel route of drug administration to treat diseases of the bladder and lower urinary tract. Inura’s technology results from decades of work in urology by Professor Grant S. Mulholland, a renowned surgeon, academic, and past President of the American Urology Association. The first indication we are addressing with the ovulum is a chronic disease, named overactive bladder (OAB). More details on https://inuramedical.ch/.