title: The influence of baseline parameters on changes in international prostate symptom score with dutasteride, tamsulosin, and combination therapy among men with symptomatic benign prostatic hyperplasia and an enlarged prostate: 2-year data from the CombAT study.
abstract: BACKGROUND
  Knowledge of baseline factors that influence outcomes for men with benign prostatic hyperplasia (BPH) receiving medical therapy may help to improve outcomes and cost effectiveness.
  
  
  OBJECTIVE
  To examine the influence of baseline parameters on changes in International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Q(max)) in men with BPH receiving dutasteride, tamsulosin, or a combination of the two using 2-yr Combination of Avodart and Tamsulosin (CombAT) study data.
  
  
  METHODS
  CombAT is an ongoing, 4-yr, multicentre, randomised, double-blind study in 4844 men aged >or=50 yr with clinical diagnosis of BPH, IPSS >or=12, prostate volume >or=30 cm(3), prostate-specific antigen (PSA) 1.5-10 ng/ml, and Q(max) >5 and <or=15 ml/s with minimum voided volume >or=125 ml.
  
  
  METHODS
  Daily tamsulosin 0.4 mg, dutasteride 0.5 mg, or the combination.
  
  
  METHODS
  Post hoc analyses of mean IPSS and Q(max) changes from baseline by treatment group and by baseline prostate volume, PSA, age, body mass index (BMI), IPSS, IPSS quality of life (QoL) score, BPH Impact Index score, Q(max), and previous BPH medical therapy.
  
  
  CONCLUSIONS
  Combination therapy was more effective than either monotherapy after 24 mo in improving IPSS in all baseline subgroups, with benefit onset varying by baseline prostate volume. Combination therapy was also more effective in improving Q(max) versus tamsulosin in all subgroups and versus dutasteride in 10 of 18 subgroups. At 24 mo, dutasteride monotherapy resulted in significantly greater IPSS improvements versus tamsulosin in men with lower age, worse symptoms, worse QoL, less bother, higher BMI, greater Q(max), higher prostate volume, and higher PSA at baseline. Post hoc analyses, the lack of placebo control, and the exclusion of men with unsuccessful medical BPH treatment are study limitations.
  
  
  CONCLUSIONS
  Combination therapy with tamsulosin and dutasteride affords the greatest and the most rapid symptomatic benefit among men with higher baseline prostate volume and is effective regardless of previous BPH medical therapy. Dutasteride monotherapy is more effective than tamsulosin in men with higher baseline prostate volume or PSA and worse symptoms.
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX 75390-9110, USA. claus.roehrborn@utsouthwestern.edu
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.forename: Paul
authors.initials: P
authors.lastname: Siami
authors.forename: Jack
authors.initials: J
authors.lastname: Barkin
authors.forename: Ronaldo
authors.initials: R
authors.lastname: Damião
authors.forename: Edgardo
authors.initials: E
authors.lastname: Becher
authors.forename: Bernardino
authors.initials: B
authors.lastname: Miñana
authors.forename: Vicenzo
authors.initials: V
authors.lastname: Mirone
authors.forename: Ramiro
authors.initials: R
authors.lastname: Castro
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D001378:Azasteroids / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000068538:Dutasteride; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011467:Prostate / Q000033:anatomy & histology / Q000187:drug effects; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000097:blood / Q000188:drug therapy*; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin
chemical_list: D000317:Adrenergic alpha-Antagonists; D001378:Azasteroids; D004791:Enzyme Inhibitors; D013449:Sulfonamides; D017430:Prostate-Specific Antigen; D000077409:Tamsulosin; D000068538:Dutasteride