<p><strong>In patients with moderate to severe predominant storage LUTS, clinicians may offer beta-3 agonists alone or in combination with an AB as a treatment option. (<em>Conditional Recommendation; Evidence Level: Grade C</em>) </strong></p>
Discussion
Discussion
<p>The use of beta-3 agonists in combination with ABs has emerging evidence of safety and symptomatic improvement. Vibegron, randomized to placebo, in men with LUTS/BPH with predominant storage LUTS on ABs or 5-ARIs, showed a significant improvement in urgency, frequency, and nocturia.<sup>205</sup> Mirabegron used alone in patients with BOO did not adversely affect Q<sub>max</sub> and detrusor pressure at Q<sub>max </sub>compared with placebo after 12 weeks of treatment.<sup>206</sup></p>
<p>One RCT (n=706) in two publications compared a beta-3 agonist combined with an AB to AB monotherapy.<sup>207, 208</sup> The PLUS trial enrolled men who had been taking tamsulosin for at least two months for LUTS/BPH; almost all had moderate or severe symptoms at baseline. Patients were randomized to add-on mirabegron or continued tamsulosin monotherapy. At 12-weeks follow-up, symptoms and quality of life were similar between combination therapy and monotherapy groups. Adverse event rates were similar between groups. The AUA/SUFU OAB Guideline supports the use of monotherapy with beta-3 agonists in patients with predominant storage LUTS and BPH.<sup>52</sup> </p>