Mirabegron: useful side effects and new promising areas of application.

Introduction. Mirabegron is a β3-adrenergic receptor agonist (β3-AR) that is registered and widely used for the treatment of overactive bladder (OAB). Initially, the drug was studied for the treatment of metabolic syndrome, but then showed the ability to influence the symptoms of urgent frequent urination. As a result, it was registered for the indication «OAB». However, the effect of mirabegron on fat metabolism and other metabolic effects should also be taken into account. These side effects of mirabegron can be «beneficial» and provide a dual effect: correction of symptoms of lower urinary tract dysfunction (LUTS) and, for example, metabolic disorders. This review is devoted to the analysis of publications that demonstrate concomitant beneficial effects of mirabegron. Materials and methods. 32 most significant publications from PubMed and eLibrary electronic libraries were analyzed. Results. The analysis of experimental studies showed that β3-AR are a target for new pharmacological approaches in the treatment of metabolic, cardiovascular, urological and ocular diseases. Potential targets of β3-AR agonists were identified as: brain, heart, adipose tissue, retina, kidneys, bladder. Mirabegron is a new, effective and safe treatment for intramural ureteral stones. Compared with the control group, mirabegron significantly improves the elimination of stones <5 mm of size (83% versus 60%). The percentage of complete stone-free rate is also higher with mirabegron than in the tamsulosin and placebo groups: 95,2%; 90,2% and 77,8%. A new concept for the treatment of obesity and diabetes is proposed: increasing energy expenditure by activating endogenous BAT through stimulation of β3-AR with mirabegron. It was shown that in all study participants receiving mirabegron, metabolic activity of BAT was significantly (p=0,001) higher than in the placebo group. When taking mirabegron, a change in adiponectin levels was demonstrated, which was +35%. In people without diabetes, changes in glucose tolerance or HbA1c (glycated hemoglobin) levels observed when taking mirabegron can be expected with weight loss of more than 16%. Stimulation of β3-AR ensures preservation of myocardial function after ischemia-reperfusion and provides benefits during loads for the heart muscle. Mirabegron also reduces the level of triglycerides in skeletal muscles and promotes the switch of other fiber types to type I fibers. 40% of men showed improvement in erectile function during treatment with OAB mirabegron. During 12-week therapy with mirabegron, sexual function in women significantly improved (42 out of 50 patients – 84%). Conclusion. Current data on the concomitant «beneficial» effects of mirabegron open up new prospects for the use of this drug, which can work for two or more indications.