Efficacy of newer medications for lower urinary tract symptoms attributed to benign prostatic hyperplasia

a systematic review

Roderick MacDonald, Michelle Brasure, Philipp Dahm, Carin M. Olson, Torie Nelson, Howard A Fink, Michael C. Risk, Bruce Rwabasonga, Timothy J Wilt

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

We conducted a systematic review to evaluate the efficacy and adverse effects of newer drugs used to treat lower urinary tract symptoms (LUTS). The drugs were either Food and Drug Administration (FDA) approved for benign prostatic hyperplasia (BPH) or not FDA approved for BPH but have been evaluated for treatment of BPH since 2008. We searched bibliographic databases through September 2017. We included randomized controlled trials (RCTs) lasting one month or longer published in English. Outcomes of interest were LUTS assessed by validated measures. Efficacy was interpreted using established thresholds indicating clinical significance that identified the minimal detectable difference. Twenty-three unique, generally short-term, RCTs evaluating over 9000 participants were identified. Alpha-blocker silodosin and phosphodiesterase type 5 inhibitor tadalafil were more effective than placebo in improving LUTS (moderate strength evidence) but these drugs had more adverse effects, including abnormal ejaculation (silodosin). Anticholinergics were only effective versus placebo when combined with an alpha-blocker. Evidence was generally low strength or insufficient for other drugs. Evidence was insufficient to assess long-term efficacy, prevention of symptom progression, need for surgical intervention, or long-term adverse effects. Longer trials are needed to assess the effect of these therapies on response rates using established minimal detectable difference thresholds, disease progression, and harms.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalAging Male
Volume22
Issue number1
DOIs
StatePublished - Jan 2 2019

Fingerprint

Lower Urinary Tract Symptoms
Prostatic Hyperplasia
United States Food and Drug Administration
Pharmaceutical Preparations
Randomized Controlled Trials
Placebos
Bibliographic Databases
Phosphodiesterase 5 Inhibitors
Ejaculation
Cholinergic Antagonists
Disease Progression
Therapeutics
silodosin

Keywords

  • 5-alpha reductase inhibitor
  • Lower urinary tract symptoms
  • alpha blockers
  • anticholinergic: systematic review
  • benign prostatic hyperplasia
  • randomized trials

PubMed: MeSH publication types

  • Journal Article
  • Systematic Review

Cite this

Efficacy of newer medications for lower urinary tract symptoms attributed to benign prostatic hyperplasia : a systematic review. / MacDonald, Roderick; Brasure, Michelle; Dahm, Philipp; Olson, Carin M.; Nelson, Torie; Fink, Howard A; Risk, Michael C.; Rwabasonga, Bruce; Wilt, Timothy J.

In: Aging Male, Vol. 22, No. 1, 02.01.2019, p. 1-11.

Research output: Contribution to journalReview article

@article{9c4097b1e64440c7b5c8e1abba7f686f,
title = "Efficacy of newer medications for lower urinary tract symptoms attributed to benign prostatic hyperplasia: a systematic review",
abstract = "We conducted a systematic review to evaluate the efficacy and adverse effects of newer drugs used to treat lower urinary tract symptoms (LUTS). The drugs were either Food and Drug Administration (FDA) approved for benign prostatic hyperplasia (BPH) or not FDA approved for BPH but have been evaluated for treatment of BPH since 2008. We searched bibliographic databases through September 2017. We included randomized controlled trials (RCTs) lasting one month or longer published in English. Outcomes of interest were LUTS assessed by validated measures. Efficacy was interpreted using established thresholds indicating clinical significance that identified the minimal detectable difference. Twenty-three unique, generally short-term, RCTs evaluating over 9000 participants were identified. Alpha-blocker silodosin and phosphodiesterase type 5 inhibitor tadalafil were more effective than placebo in improving LUTS (moderate strength evidence) but these drugs had more adverse effects, including abnormal ejaculation (silodosin). Anticholinergics were only effective versus placebo when combined with an alpha-blocker. Evidence was generally low strength or insufficient for other drugs. Evidence was insufficient to assess long-term efficacy, prevention of symptom progression, need for surgical intervention, or long-term adverse effects. Longer trials are needed to assess the effect of these therapies on response rates using established minimal detectable difference thresholds, disease progression, and harms.",
keywords = "5-alpha reductase inhibitor, Lower urinary tract symptoms, alpha blockers, anticholinergic: systematic review, benign prostatic hyperplasia, randomized trials",
author = "Roderick MacDonald and Michelle Brasure and Philipp Dahm and Olson, {Carin M.} and Torie Nelson and Fink, {Howard A} and Risk, {Michael C.} and Bruce Rwabasonga and Wilt, {Timothy J}",
year = "2019",
month = "1",
day = "2",
doi = "10.1080/13685538.2018.1434503",
language = "English (US)",
volume = "22",
pages = "1--11",
journal = "Aging Male",
issn = "1368-5538",
publisher = "Informa Healthcare",
number = "1",

}

TY - JOUR

T1 - Efficacy of newer medications for lower urinary tract symptoms attributed to benign prostatic hyperplasia

T2 - a systematic review

AU - MacDonald, Roderick

AU - Brasure, Michelle

AU - Dahm, Philipp

AU - Olson, Carin M.

AU - Nelson, Torie

AU - Fink, Howard A

AU - Risk, Michael C.

AU - Rwabasonga, Bruce

AU - Wilt, Timothy J

PY - 2019/1/2

Y1 - 2019/1/2

N2 - We conducted a systematic review to evaluate the efficacy and adverse effects of newer drugs used to treat lower urinary tract symptoms (LUTS). The drugs were either Food and Drug Administration (FDA) approved for benign prostatic hyperplasia (BPH) or not FDA approved for BPH but have been evaluated for treatment of BPH since 2008. We searched bibliographic databases through September 2017. We included randomized controlled trials (RCTs) lasting one month or longer published in English. Outcomes of interest were LUTS assessed by validated measures. Efficacy was interpreted using established thresholds indicating clinical significance that identified the minimal detectable difference. Twenty-three unique, generally short-term, RCTs evaluating over 9000 participants were identified. Alpha-blocker silodosin and phosphodiesterase type 5 inhibitor tadalafil were more effective than placebo in improving LUTS (moderate strength evidence) but these drugs had more adverse effects, including abnormal ejaculation (silodosin). Anticholinergics were only effective versus placebo when combined with an alpha-blocker. Evidence was generally low strength or insufficient for other drugs. Evidence was insufficient to assess long-term efficacy, prevention of symptom progression, need for surgical intervention, or long-term adverse effects. Longer trials are needed to assess the effect of these therapies on response rates using established minimal detectable difference thresholds, disease progression, and harms.

AB - We conducted a systematic review to evaluate the efficacy and adverse effects of newer drugs used to treat lower urinary tract symptoms (LUTS). The drugs were either Food and Drug Administration (FDA) approved for benign prostatic hyperplasia (BPH) or not FDA approved for BPH but have been evaluated for treatment of BPH since 2008. We searched bibliographic databases through September 2017. We included randomized controlled trials (RCTs) lasting one month or longer published in English. Outcomes of interest were LUTS assessed by validated measures. Efficacy was interpreted using established thresholds indicating clinical significance that identified the minimal detectable difference. Twenty-three unique, generally short-term, RCTs evaluating over 9000 participants were identified. Alpha-blocker silodosin and phosphodiesterase type 5 inhibitor tadalafil were more effective than placebo in improving LUTS (moderate strength evidence) but these drugs had more adverse effects, including abnormal ejaculation (silodosin). Anticholinergics were only effective versus placebo when combined with an alpha-blocker. Evidence was generally low strength or insufficient for other drugs. Evidence was insufficient to assess long-term efficacy, prevention of symptom progression, need for surgical intervention, or long-term adverse effects. Longer trials are needed to assess the effect of these therapies on response rates using established minimal detectable difference thresholds, disease progression, and harms.

KW - 5-alpha reductase inhibitor

KW - Lower urinary tract symptoms

KW - alpha blockers

KW - anticholinergic: systematic review

KW - benign prostatic hyperplasia

KW - randomized trials

UR - http://www.scopus.com/inward/record.url?scp=85060171573&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060171573&partnerID=8YFLogxK

U2 - 10.1080/13685538.2018.1434503

DO - 10.1080/13685538.2018.1434503

M3 - Review article

VL - 22

SP - 1

EP - 11

JO - Aging Male

JF - Aging Male

SN - 1368-5538

IS - 1

ER -