Comparison of the Efficacy of Vibegron and Fesoterodine for Neurogenic Detrusor Overactivity in Individuals With Spinal Cord Lesion: A Single‐Center Prospective Randomized Crossover Trial

Introduction To compare the efficacy of the β3 agonist vibegron and the anticholinergic agent fesoterodine in the management of neurogenic detrusor overactivity (NDO) in individuals with spinal cord lesion (SCL). Materials and Methods This was a single‐center, prospective, open‐label, randomized, crossover study. A total of 41 individuals with SCL undergoing clean intermittent catheterization, who required pharmacological treatment for NDO confirmed by cystometrogram (CMG), were enrolled in the study. Most patients were < 6 months from SCL. Patients were randomly assigned to receive either vibegron (50 mg) or fesoterodine (4 mg) in a crossover design for 4 weeks each, with no washout period between treatments. The efficacy of the two medications was evaluated during the first 4 weeks using CMG parameters and the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF). At the end of the second 4‐week period, participants were surveyed on their preference for the continuation of either drug, based on efficacy, adverse events, and overall satisfaction. Results During the first 4 weeks, CMG parameters, including detrusor pressure and cystometric capacity, significantly improved in both groups, with no significant differences observed between the groups. The ICIQ‐SF scores also demonstrated significant improvements in almost all items in both groups; however, the improvements in Q3 (Overall impact of UI) and the total score were significantly better in the vibegron group. At the end of the second 4‐week period, participant survey results indicated that 58% preferred vibegron, 6% preferred fesoterodine, and 36% rated both as equivalent for future continuation therapy. Conclusion Vibegron significantly improved CMG parameters in addition to alleviating UI symptoms, demonstrating efficacy that was not inferior to that of fesoterodine. With a lower incidence of adverse events and high patient satisfaction, vibegron may serve as a useful therapeutic option for the treatment of NDO in individuals with SCL.