CONTEXT: OnabotulinumtoxinA and mirabegron have recently gained marketing 
authorisation to treat symptoms of overactive bladder (OAB).
OBJECTIVE: To evaluate the relative efficacy of mirabegron and 
onabotulinumtoxinA in patients with idiopathic OAB.
DESIGN: Network meta-analysis.
DATA SOURCES: A search of 9 electronic databases, review documents, guidelines 
and websites.
METHODS: Randomised trials comparing any licensed dose of onabotulinumtoxinA or 
mirabegron with each other, anticholinergic drugs or placebo were eligible (19 
randomised trials were identified). 1 reviewer extracted data from the studies 
and a second reviewer checked the data. Candidate trials were assessed for 
similarity and networks were developed for each outcome. Bayesian network 
meta-analysis was conducted using both fixed-effects and random-effects models. 
When there were differences in mean baseline values between mirabegron and 
onabotulinumtoxinA trials they were adjusted for using network meta-regression 
(NMR).
RESULTS: No studies directly comparing onabotulinumtoxinA to mirabegron were 
identified. A network was created for each of the 7 outcomes, with 3-9 studies 
included in each individual network. The trials included in the networks were 
broadly similar. Patients in the onabotulinumtoxinA trials had more urinary 
incontinence and urgency episodes at baseline than patients in the mirabegron 
trials and these differences were adjusted for using NMR. Both 
onabotulinumtoxinA and mirabegron were more efficacious than placebo at reducing 
the frequency of urinary incontinence, urgency, urination and nocturia. 
OnabotulinumtoxinA was more efficacious than mirabegron (50 and 25 mg) in 
completely resolving daily episodes of urinary incontinence and urgency and in 
reducing the frequency of urinary incontinence, urgency and urination. NMR 
supported the results of the network meta-analysis.
CONCLUSIONS: In the absence of head-to-head trials comparing onabotulinumtoxinA 
to mirabegron, this indirect comparison indicates that onabotulinumtoxinA may be 
superior to mirabegron in improving symptoms of urinary incontinence, urgency 
and urinary frequency in patients with idiopathic OAB.