Is Mirabegron-the novel beta 3 agonist-effective in patients with heart failure? A systematic review and meta-analysis of efficacy and safety

OBJECTIVE: Our goal is to conduct an investigation into the safety and efficacy of 𝛽3 agonist (Mirabegron) in patients with heart failure (HF) comparing it to placebo. METHODS: We searched internet databases for eligible randomized controlled trials (RCTs) up to April 1st, 2024. Heart rate, stroke volume, systolic blood pressure, cardiac index, and adverse events were the primary outcomes that were analyzed. Inverse variance was used to compute the risk ratio (RR) and pooled mean differences (MD), along with their 95% CI. RESULTS: Four studies were included in our paper with a total of 454 patients. The mirabegron group showed a statistically significant improvement compared to the placebo group in Cardiac index (MD: 0.28, 95% CI: 0.02 , 0.53, P = 0.03), but pooled analysis did not favor either of the two arms in heart rate, ejection fraction, stroke volume and systolic blood pressure (MD: 2.54, 95% CI: -1.05 , 6.13), (MD: 2.40, 95% CI: -2.51 , 7.3), (MD: 0.56, 95% CI: -2.45 , 3.56), and (MD: 0.11, 95% CI:-0.15 , 0.38) respectively. Furthermore, there were not significant variations between the two groups in adverse events, and serious adverse events (RR: 1.06, 95% CI: 0.87, 1.29), and (RR: 1.06, 95% CI: 0.70, 1.60, p = 0.80) respectively. CONCLUSION: The Cardiac index was considerably enhanced with Mirabegron, but all other effectiveness and safety outcomes were unchanged. Further RCTs for longer durations and on more diverse populations still need to be conducted.