Efficacy and safety of tamsulosin hydrochloride compared to doxazosin in the treatment of Indonesian patients with lower urinary tract symptoms due to benign prostatic hyperplasia

Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis

Despite the availability of various drugs for benign prostatic hyperplasia (BPH), alpha(α)-blockers are the preferred first-line treatment. However, there remains a scarcity of direct comparisons among various α-blockers. Therefore, this network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of α-blockers in the management of BPH. A comprehensive electronic search covered PubMed, Embase, Ovid MEDLINE, and Cochrane Library until August 2023. The primary endpoints comprised international prostate symptom score (IPSS), maximum flow rate (Qmax), quality of life (QoL), and post-void residual volume (PVR), while treatment-emergent adverse events (TEAEs) were considered as secondary endpoints. This NMA synthesized evidence from 22 studies covering 3371 patients with six kinds of α-blockers with 12 dose categories. IPSS has been considerably improved by tamsulosin 0.4 mg, naftopidil 50 mg and silodosin 8 mg as compared to the placebo. Based on the p-score, tamsulosin 0.4 mg had the highest probability of ranking for IPSS, PVR, and Qmax, whereas doxazosin 8 mg had the highest probability of improving QoL. A total of 297 adverse events were reported among all the α-blockers, silodosin has reported a notable number of TEAEs. Current evidence supports α-blockers are effective in IPSS reduction and are considered safer. Larger sample size with long-term studies are needed to refine estimates of IPSS, QoL, PVR, and Qmax outcomes in α-blocker users.

Efficacy and tolerability of doxazosin gastro-intestinal therapeutic system versus tamsulosin in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: A systematic review and meta-analysis

BACKGROUND

Alpha1-adrenoceptor antagonists (α1-blockers) are first-line drugs for the treatment of lower urinary tract symptoms associated with benign prostate hyperplasia (BPH). Doxazosin gastrointestinal therapeutic system (GITS) and tamsulosin belong to the 2 most frequently prescribed α1-blockers. This systematic review and meta-analysis was performed to compare the efficacy and tolerability of these 2 α1-blockers.

METHODS

A systematic review of published randomized controlled trials in English or Chinese language was performed using the PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and Vip databases. After data extraction and quality assessment, the meta-analysis was performed to compare clinical parameters (International Prostate Symptom Score [IPSS] total [IPSS-T], storage [IPSS-S], voiding [IPSS-V], maximum urine flow [Qmax], and postvoid residual) and adverse events (AEs) that changed after first drug intake.

RESULTS

After the screening, 8 eligible randomized controlled trials with 1316 patients were identified. Doxazosin-GITS showed a significantly higher efficacy compared with tamsulosin (IPSS-T P < .001, IPSS-S P < .001, and IPSS-V P < .001). There were no significant differences between the 2 drugs for changes in Qmax (P = .477) or postvoid residual (P = .739). The overall AEs were significantly lower in the doxazosin-GITS group (risk ratio: 0.77; 95% CI: 0.54-1.08; P = .036). However, dizziness (P = .387), headache (P = .745), asthenia (P = .693), postural hypotension (P = .114), and retrograde ejaculation (P = .187) were similar between the 2 groups.

CONCLUSIONS

This meta-analysis indicates that doxazosin-GITS has significantly higher efficacy and lower AEs than tamsulosin in patients with lower urinary tract symptoms/benign prostate hyperplasia.

The impact of metabolic syndrome on the responsiveness to α1-blocker in men with BPH/LUTS

AIMS

Increasing evidence has proposed the components of metabolic syndrome (MtS) as risk factors for the development of benign prostate hyperplasia (BPH); therefore, it is thought that MtS may play a role in lower urinary tract symptoms related to BPH (BPH/LUTS) aetiology. Considering the closed relationships between MtS and BPH/LUTS, it is possible that patients with MtS might have different drug responsiveness in men with BPH/LUTS. We prospectively investigated the impact of MtS on responsiveness to α1-blocker in men with BPH/LUTS.

METHODS

We enrolled a total of 109 patients with a mean (SD) age of 59.8 (9.0) years, having a prostate volume of 20 cm(3) or greater with moderate to severe LUTS. All patients received doxazosin GITS (gastrointestinal therapeutic system) 4 mg once daily for a 12-week period of treatment. The efficacy measurement was assessed by the changes from baseline in the total IPSS, maximum urinary flow rate and postvoid residual urine volume. The drug responders were defined as those who had a total IPSS decrease of more than 4 points from baseline after 12 weeks of treatment.

RESULTS

Using multiple logistic regression analysis, our results showed that MtS was an independent factor for drug non-responder (OR = 4.26, p = 0.002). The rate of drug responder and total IPSS improvements in patients with MtS significantly decreased as the number of MtS components increased (p = 0.012 and p = 0.026). Among the MtS components, abnormal fasting blood glucose (FBG) was the most significantly independent factor for drug non-responder (OR = 3.17, p = 0.020).

CONCLUSION

This study suggested that the presence of MtS had a significantly negative impact on the responsiveness to α1-blocker in men with BPH/LUTS. Our results are important for BPH/LUTS patients who did not initially respond to α1-blocker or who strive to reduce these metabolic risk factors.

Long-term outcome of tamsulosin for patients with lower urinary tract symptoms according to the treatment response defined by lower urinary tract symptom outcomes score

IMS: To evaluate long-term outcome of tamsuolsin 0.2 mg for benign prostatic hyperplasia (BPH) patients using a new subjective assessment of patient-reported outcomes and the lower urinary tract symptoms (LUTS) outcome score (LOS) over a 48-week period.

METHODS

This study investigated the long-term outcomes of either well-responded or poorly responded patient group as defined by LOS at the period of 12 weeks after BPH treatment. Outcome parameters used in this study were the most bothersome symptoms, BPH K1-short form as well as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and postvoiding residual urine volume at 24-, 36- and 48-week follow-up.

RESULTS

Of the 414 patients recruited initially, 310 (75.2%) were defined as the responders and 39 (9.5%) as the non-responders to the treatment at 12 weeks, which was stratified by LOS. In this long-term study, the differences in improvement rates of clinical parameters between responder and non-responder groups at 12 weeks of treatment were maintained over the period of 48 weeks. Among the responder patients, most (75.6%) chose continuous administrations of tamsulosin. Improvements in clinical parameters were maintained in this subgroup. It is noteworthy that the improvements in clinical parameters of the non-responder group were dismal despite switching to the other treatment modalities.

CONCLUSIONS

Long-term tamsulosin 0.2 mg for BPH patients is an effective treatment, both subjectively and objectively. Considering its integrative nature, LOS seemed to be one of the useful tools to predict the outcome after the management of LUTS.

Extended-release doxazosin for treatment of renal transplant recipients with benign prostatic hyperplasia

We studied living-related donor renal transplant recipients with benign prostatic hyperplasia (BPH). No prisoners were used in the study either as donors or recipients. We sought to assess the effectiveness and safety of extended-release doxazosin for treatment of renal transplant recipients with BPH.

METHODS

Forty-six recipients were diagnosed with BPH. Their transplanted kidney functions were stable. They received 4 or 8 mg/d of extended-release doxazosin orally. After 2, 4, 12, and 24 weeks, changes in the International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Q(max)), residual urine, blood pressure, renal graft function, and trough immunosuppressant concentrations were analyzed by a prospective, self-calibrated method.

RESULTS

The effectiveness rate of extended-release doxazosin in renal transplant recipients with BPH was 63.04% (29/46). Compared with their status before they took doxazosin, IPSS and residual urine decreased significantly, whereas Q(max) and QoL increased significantly at 2, 4, 12, and 24 weeks after treatment (P < .01). In 15 renal transplant recipients with hypertension, systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly decreased at 2, 4, 12, and 24 weeks after treatment (P < .01); blood pressure became normal in 10 patients (66.67%). The differences in renal graft function and trough concentration of immunosuppressants before versus after treatment were not significant.

CONCLUSION

Extended-release doxazosin treatment was effective and safe in renal transplant recipients with BPH. The drug not only had no influence on renal graft function and trough concentrations of immunosuppressant, but improved hypertension in these patients.

Assessment of patient-reported outcome of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia and treated with tamsulosin HCl in Korea

OBJECTIVES

To evaluate the effect of tamsulosin 0.2 mg once daily in treatment of patients with benign prostatic hyperplasia (BPH) using the new subjective assessment of patient-reported outcomes and the lower urinary tract symptoms (LUTS) outcome score (LOS).

METHODS

Of 370 patients from 9 urology outpatient clinics, 299 finished this study. Tamsulosin 0.2 mg once daily was administered orally in a nonblind design for a 12-week period. The primary endpoint of this study was to evaluate the effect of tamsulosin with new assessing parameters; the most bothersome symptoms, BPH K1-short form and LOS. The secondary endpoint was to evaluate the effect of tamsulosin with conventional parameters, International Prostate Symptom Score (IPSS), maximum flow rate (Q(max.)), and postvoiding residual urine volume.

RESULTS

A total of 189 (63.2%) of 299 patients responded that their most bothersome symptom had been improved at 12 weeks after study. All 9 items in BPH K1-short form showed statistically significant improvement (P <.05). Overall, 20 (6.7%) patients met criteria for cured, 246 (82.3%) for improved, and 33 (11.0%) for failed. Statistically significant improvements were observed in IPSS, Q(max.), and postvoiding residual urine volume (P <.05).

CONCLUSIONS

Tamsulosin 0.2 mg once daily may be an effective treatment, subjectively and objectively in patients with BPH. To evaluate the effect of the treatment in patients with BPH, it may be more effective to use the subjective quality of life questionnaire and the subjective-objective data integrated LOS than the currently used IPSS and Q(max.).

Comparing the therapeutic outcome of different alpha-blocker treatments for BPH in the same individuals

OBJECTIVE

Alpha-blockers are the most widely used agents to treat lower urinary tract symptoms in males, and switching between alpha-blockers is a frequent management option when the desired effect could not be obtained. There is no data in the literature that reveal the outcome of treatments with different alpha-blockers within the same patient. We sought the answer to this question in a setting where the same individuals were treated with two different agents during different time frames.

MATERIALS AND METHODS

Forty males with benign prostatic hyperplasia (BPH) applying to the Department of Urology with lower urinary tract symptoms (LUTS) were enrolled in the study consecutively. Patients were evaluated with detailed medical history, IPSS forms, digital rectal examination (DRE), urinary ultrasound, PSA, and uroflowmetry. The subjects received terazosin 5 mg daily for 3 months, and controlled release form of alfuzosin 10 mg daily for another 3 months, leaving a 1-month clearance period in between. The above-mentioned detailed evaluations were carried out before and after each alpha-blocker regimen.

RESULTS

Mean age and PSA level was 63.3+/-1.6 years (45-80), and 2.1+/-0.4 ng/ml (0.16-6.3 ng/ml). IPSS and Qmax values before treatment with terazosin and alfuzosin were similar. Improvements in IPSS and Qmax values after treatments with both terazosin and alfuzosin were significant. There was no statistically significant difference between the drugs in terms of percent improvements in IPSS and Qmax with alpha-blocker treatment. No untoward effect except for transient dizziness in one case with terazosin treatment was encountered.

CONCLUSION

Different alpha-blockers, which are used during different time frames in the same individuals, provide similar efficiency outcome. When the desired effect in the treatment for BPH could not be obtained with one alpha-blocker, there may not be any benefit in switching to another one.