Vibegron in overactive bladder: a comprehensive review of efficacy, safety and patient-reported outcomes

Introduction Overactive bladder (OAB) is a prevalent and potentially debilitating syndrome that significantly impairs quality of life. Mirabegron and vibegron are β3-adrenoceptor (β3AR) agonists that provide a different mechanism of action to antimuscarinic medications. Vibegron has high β3AR selectivity and enhances detrusor relaxation without compromising voiding function. This review summarises the clinical and real-world evidence supporting the efficacy, safety and patient-reported benefits of vibegron in OAB.

Methods A comprehensive search of the PubMed database was conducted in December 2024 using the keyword "vibegron". This search yielded 123 entries, which were subsequently screened by title for relevance to the objectives of this narrative review. All relevant articles identified through this process were included.

Results Pivotal phase III trials have demonstrated significant reductions in urgency, urinary frequency and urgency urinary incontinence with vibegron, with rapid onset of action and a more favourable tolerability profile than antimuscarinics. The benefits of vibegron were consistent across diverse patient populations, including older adults and those with concomitant benign prostatic hyperplasia. Real-world data further suggest that vibegron is associated with improved adherence and persistence compared with other OAB therapies. Additionally, cardiovascular safety studies confirm that vibegron has no clinically significant effects on blood pressure or heart rate. While comparative trials with mirabegron indicate similar efficacy, vibegron’s higher β3AR selectivity and lack of cytochrome P450 interactions offer advantages in specific patient groups. Ongoing research, including real-world phase IV studies, aims to further define the long-term effectiveness and safety of vibegron in clinical practice.

Conclusion Vibegron represents an important advance in the pharmacologic management of OAB, providing a well-tolerated and effective alternative to existing therapies.