EURURO Vol. 71 No. 4

Platinum Priority – Review – Benign Prostatic Hyperplasia

Editorial by Malte Rieken and Christian Gratzke on pp. 582–583 of this issue

Comparative

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Effectiveness of Newer Medications for Lower

Urinary Tract Symptoms Attributed to Benign Prostatic

Hyperplasia: A Systematic Review and Meta-analysis

Philipp Dahm

a , * ,

Michelle Brasure

b ,

Roderick MacDonald

a ,

Carin M. Olson

b ,

Victoria A. Nelson

b ,

Howard A. Fink

c ,

Bruce Rwabasonga

b ,

Michael C. Risk

a , d ,

Timothy J. Wilt

e , f

Minneapolis VA Health Care System, Minneapolis, MN, USA;

Division of Health Policy and Management, University of Minnesota, School of Public Health,

Minneapolis, MN, USA;

Geriatric Research Education and Clinical Center, Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA;

Department of Urology, University of Minnesota, Minneapolis, MN, USA;

Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA;

Department of Medicine, University of Minnesota, Minneapolis, MN, USA

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 5 7 0 – 5 8 1

available at

www.scienced irect.com

journal homepage:

www.europeanurology.com

Article info

Article history:

Accepted September 16, 2016

Associate Editor:

Christian Gratzke

Keywords:

Lower urinary tract symptoms

Benign prostatic hyperplasia

Alpha blockers

5-alpha reductase inhibitor

Systematic review

Comparative effectiveness

Randomized trials

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Abstract

Context:

Alpha-blockers (ABs) and 5-alpha reductase inhibitors have an established role in

treating male lower urinary tract symptoms (LUTS) attributed to benign prostatic hyper-

plasia (BPH). Recently, newer drugs have shown promise for this indication.

Objective:

To assess the comparative effectiveness and adverse effects (AEs) of newer drugs

to treat LUTS attributed to BPH through a systematic review and meta-analysis.

Evidence acquisition:

Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and

Ovid Embase bibliographic databases (through June 2016) were hand searches for refer-

ences of relevant studies. Eligible studies included randomized controlled trials published in

English of newer ABs, antimuscarinics, a beta-3 adrenoceptor agonist, phosphodiesterase

type-5 inhibitors, or combination therapy with one of these medications as an active

comparator. Observational studies of the same agents with a duration 1 yr that reported

AEs were also included.

Evidence synthesis:

We synthesized evidence from 43 randomized controlled trials as well

as five observational studies. Based on improvement of mean International Prostate Symptom

Score and quality of life scores, the effectiveness of the newer ABs was not different from the

older ABs (moderate strength of evidence [SOE]), but had more AEs (low SOE). Antimuscari-

nics/AB combination therapy had similar outcomes as AB monotherapy (all moderate SOE),

but often had more AEs. Phosphodiesterase type-5 inhibitors alone or in combination with

ABs had similar or inferior outcomes than ABs alone. Evidence was insufficient for the beta-3

adrenoceptor agonist. For all newer agents, the evidence was generally insufficient to assess

long-term efficacy, prevention of symptom progression, or AEs.

Conclusions:

None of the drugs or drug combinations newly used to treat LUTS attributed to

BPH showed outcomes superior to traditional AB treatment. Given the lack of superior

outcomes, the studies’ short time-horizon, and less assurance of their safety, their current

value in treating LUTS attributable to BPH appears low.

Patient summary:

In this paper, we reviewed the evidence of newer drugs to treat men with

urinary problems attributable to an enlarged prostate. We found none of the new drugs to be

better but there was more concern about side effects.

* Corresponding author. Minneapolis VA Health Care System, Urology Section, 1 Veterans Drive, Mail

Code 112D, Minneapolis, MN 55417, USA. Tel. +1 352 6825130; Fax: +1 612 626 0428.

E-mail addresses:

pdahm@umn.edu

dahmph@me.com

(P. Dahm).

http://dx.doi.org/10.1016/j.eururo.2016.09.032

0302-2838/