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BetmigaTM (mirabegron) is indicated for symptomatic treatment of urgency, increased micturition frequency and/or urgency incontinence as may occur in adult patients with overactive bladder (OAB) syndrome and for treatment of neurogenic detrusor overactivity (NDO) in paediatric patients aged 3 to <18 years.1

The prevalence of OAB increases with age, affecting approximately 30% of people >65 years of age2

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Multiple medicines with anticholinergic activity may cumulatively contribute to anticholinergic burden (ACB)3,4

Anticholinergic drugs block acetylcholine receptors as an intended therapeutic action, or as an unintended off-target effect. Many medicines, including antimuscarinics have anticholinergic effects3,4

The cumulative impact of multiple drugs with this effect is known as ACB.4

patient

AEs associated with anticholinergic activity tend to be more prevalent in older patients5

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ACB may increase in those taking multiple such medicines6,7

cognitive decline

In older patients, medicines with anticholinergic activity may also contribute to cognitive decline over time4

TEAEs are a common reason for antimuscarinic discontinuation in patients with OAB8

ACB, anticholinergic burden; AE, adverse event; OAB, overactive bladder; TEAE, treatment-emergent adverse event.

ACB is a guideline-recommended treatment consideration9

EAU Guidelines

*Strength rating: Strong.

ACB, anticholinergic burden; AE, adverse event; EAU, European Association of Urology; LE, level of evidence; OAB, overactive bladder; UUI, Urge Urinary Incontinence.

 

The prevalence of OAB increases with age, affecting approximately 30% of individuals >65 years of age2. This age group are often under represented in clinical trials.

The PILLAR study is a phase IV study of elderly patients, including those aged 75 years and older, having several comorbidities and concomitant medications.

 

Study design

EoT, end of treatment; OAB, overactive bladder; RCT, randomised controlled trial.

Efficacy Safety

*Adjusted mean changes generated from ANCOVA models with treatment, sex (<75 years or ≥75 years) and country as fixed factors, and baseline value as a covariate.

†TEAE defined as an adverse event that started or worsened in the period from first double-blind medication intake until 30 days after the last double-blind medication intake. The number of patients reporting an event is presented.

‡Affecting 2% of any treatment group.

CfB, change from baseline; CI, confidence interval; SE, standard error; TEAE, treatment-emergent adverse event.

CONCLUSION

  • Significant improvements in OAB symptoms were seen in patients ≥65 years and ≥75 years
  • No new safety concerns were found
  • Statistically significant reductions in the mean numbers of micturitions (p<0.001) and incontinence episodes (p<0.001) over 12 weeks

References

1. BETMIGA (mirabegron) prolonged-release tablets. Summary of Product Characteristics 2. Nitti VW et al. Int J Clin Pract. 2013;67(7):619-632. 3. Green AR, et al. Drugs Aging. 2019;36(3):289–297. 4. Hilmer SN, Gnjidic D. Aust Prescr. 2022;45(4):118–120 5. Rudolph JL, et al. Arch Intern Med. 2008;168:508–513 6. Mintzer J and Burns A. J R Soc Med. 2000;93:457–462. 7. Parkinson L, et al. Med J Aust. 2015;202:91–94 8. Benner JS, et al. BJU Int. 2010;105(9):1276–1282. 9. EAU Guidelines on Management of Non-Neurogenic Female Lower Urinary Tract Symptoms. Available online: https://uroweb.org/guidelines/non-neurogenic-female-luts. Accessed January 2026. 10. Wagg A, et al. Eur Urol. 2020;77(2):211–220.

Adverse events should be reported. For Ireland, Healthcare professionals are asked to report any suspected adverse reactions via: HPRA Pharmacovigilance, Website: www.hpra.ie or Astellas Pharma Co. Ltd. Tel:+353 1 467 1555, E-mail: irishdrugsafety@astellas.com.

MAT-IE-BET-2026-00008 Sep 2026