NIGHTTIME dosing of mirabegron improves nocturia and urgency symptoms in women with overactive bladder more effectively in the short term, while daytime dosing appears to enhance emotional outcomes.
Overactive bladder (OAB) significantly impacts quality of life, and optimising treatment regimens is essential for clinical practice. Mirabegron, a β3-adrenoceptor agonist, is widely used to manage OAB symptoms, yet the influence of dosing time on therapeutic efficacy has not been fully established. This study aimed to determine whether administering mirabegron during the night versus the day affects symptom relief, emotional well-being, and overall treatment outcomes in women with OAB. Understanding the relationship between dosing time and symptom control may inform more tailored clinical approaches for improving patient quality of life.
Between August 2017 and August 2023, 109 women diagnosed with OAB were randomly assigned to receive mirabegron 25 mg either at night (n=57) or during the day (n=52) for 12 weeks. Nocturia episodes significantly decreased in the nighttime dosing group from 5.65 ± 3.71 at baseline to 4.26±2.60 at 4 weeks (p=0.019), whereas no improvement was observed in the daytime group. Nighttime dosing also resulted in greater reductions in urgency episodes during 06:00–12:00 (−2.1±3.7 versus 0.1±2.4, p=0.003), 18:00–24:00 (−1.4±3.0 versus 0.4±2.7, p=0.01), and overall daily urgency (−6.4±10.8 versus 0.1±8.5, p=0.005) at 4 weeks compared to daytime dosing. Conversely, daytime dosing significantly improved emotional scores (−17±25 versus −6±19, p=0.006) relative to nighttime dosing. By 12 weeks, both groups demonstrated comparable improvement in overall OAB symptoms. Younger age (coefficient: 0.065; p=0.039) and higher baseline Overactive Bladder Symptom Score (OABSS) (coefficient: −0.389; p=0.002) independently predicted OABSS improvement.
These findings suggest that clinicians may consider timing mirabegron administration based on individual symptom patterns. Nighttime dosing may particularly benefit women with pronounced nocturia and morning urgency, while daytime dosing could be prioritised for those experiencing coexistent emotional dysfunction. Future research should explore longer-term outcomes, patient-reported quality of life, and combination strategies to optimise symptom control and wellbeing. Incorporating dosing time considerations into routine practice could enhance personalised treatment approaches for women with OAB.
Reference
Hsiao SM. Mirabegron nighttime versus daytime dosing for women with overactive bladder syndrome: a randomized controlled trial. Sci Rep. 2025;DOI:10.1038/s41598-025-15780-5.