Vibegron, mirabegron, and other add-on therapies for persistent overactive bladder symptoms in α1-blocker-treated men with benign prostatic hyperplasia: a systematic review and Bayesian network meta-analysis.

PURPOSE: To compare the efficacy and safety of vibegron, mirabegron, and other add-on therapies for overactive bladder (OAB)/storage symptoms persisting despite α1-blocker treatment in men with benign prostatic hyperplasia (BPH), focusing on the indirect vibegron-mirabegron comparison. METHODS: We searched PubMed, Web of Science, CENTRAL, ClinicalTrials.gov, and Google Scholar through 27 August 2026. Bayesian random-effects network meta-analyses used mean differences for continuous outcomes and odds ratios (ORs) for study-reported treatment-period adverse events (AEs). Confidence was appraised with CINeMA. RESULTS: Eighteen trials were included; 16 contributed quantitative data. Versus control, vibegron reduced micturitions per 24 h (mean difference - 0.81, 95% credible interval [CrI] - 1.31 to - 0.38) and urgency episodes per day (- 0.96, - 1.57 to - 0.34), and mirabegron reduced micturitions by 0.46 per 24 h (- 0.88 to - 0.02). For vibegron versus mirabegron, indirect estimates were - 0.35 micturitions per 24 h (- 1.05 to 0.26) and - 0.52 urgency episodes per day (- 1.33 to 0.35), with all 95% CrIs including the null value. Reported AE odds were also inconclusive versus mirabegron (OR 1.50, 0.69 to 3.14), and AE definitions varied. Confidence was moderate for vibegron versus control on micturitions and urgency and low for indirect and safety estimates. CONCLUSION: Vibegron reduced micturition frequency and urgency versus control and may be considered an add-on option in α1-blocker-treated men. The vibegron node rested on two trials, and no advantage over mirabegron was established; posterior probabilities above 0.8 do not indicate superiority when credible intervals include the null value. REGISTRATION: PROSPERO CRD420261434850.