2026 CONVENTION
Influence of fed state and meal fat content on mirabegron pharmacokinetics: a systematic review and meta-analysis in healthy adults
Mirabegron, a β3-adrenoceptor agonist for overactive bladder, has shown food-related exposure shifts in individual PK studies, but these have never been quantitatively pooled. This study characterized oral mirabegron PK by meal status and assessed sex/race differences. Nine single-dose PK studies of the OCAS formulation in healthy adults were identified via systematic review. Exposure metrics were dose-normalized, and PK parameters were pooled using random-effects models, stratified by meal status, sex, and race. Dose-normalized Cmax was 0.74 (95% CI 0.65–0.83), 0.35 (0.27–0.43), and 0.26 (0.18–0.34) ng/mL/mg for fasting, high-fat, and low-fat conditions (53%, 65% lower with food). Dose-normalized AUCinf was 7.04 (6.43–7.64), 5.21 (3.94–6.49), and 3.87 (2.96–4.78) ng·h/mL/mg (26%, 45% reductions). Tmax was delayed 1.3–1.5 h under both fed states. CL/F rose from 158.0 to 209.2 and 270.0 L/h; t½ changed only modestly (35.6, 37.7, and 42.9 h). Sex/race showed no effect on any parameter. Meal status was the strongest covariate, lowering dose-normalized Cmax and AUC and delaying absorption, with low-fat meals causing greater attenuation than high-fat. The CL/F increase without a proportional t½ change suggests reduced bioavailability rather than faster elimination. These pooled estimates provide a quantitative benchmark for future model-based interstudy PK heterogeneity analyses.