Does the combination of an alpha1-adrenergic antagonist with a 5alpha-reductase inhibitor improve urinary symptoms more than either monotherapy?
BACKGROUND
Alpha1-adrenergic antagonists relieve lower urinary tract symptoms related to benign prostatic hyperplasia. 5alpha-Reductase inhibitors (ARIs) can halt the disease's progression. To assess whether their combined use had an additive benefit, we identified and summarized all randomized controlled trials in which the combination of an alpha1-adrenergic antagonist and ARI was used to treat symptomatic benign prostatic hyperplasia.


METHODS
We searched the literature for studies relating to combination medical therapy using the MEDLINE database from 1 January 1993 to 31 December 2008. Only randomized controlled trials were eligible. Data from four trials were examined. The main outcome was a change in a man's lower urinary tract symptom from baseline as measured by validated symptom scores.


RESULTS
For men with mean prostate volumes of approximately 36 ml, significant decreases from baseline symptom scores were evident after 1 year when comparing alpha1-adrenergic antagonist monotherapy and combination medical therapy with ARI monotherapy and placebo, but the mean decreases between those receiving alpha1-adrenergic antagonist monotherapy and combination medical therapy were not significantly different. However, at longer follow-up (mean 4.5 years), combination medical therapy demonstrated superiority over alpha1-adrenergic antagonist monotherapy. For men with larger prostates (mean volumes of 55 ml), combination medical therapy resulted in significantly greater improvements in symptoms compared with alpha1-adrenergic antagonist monotherapy after as little as 9 months of treatment.


CONCLUSIONS
Combination medical therapy improves lower urinary tract symptom in men with symptomatic benign prostatic hyperplasia over alpha1-adrenergic antagonist or ARI monotherapy, when prescribed on a long-term basis. Combination medical therapy is efficacious for men with moderately enlarged prostates starting at 25 ml and somewhat better for increasingly larger prostate sizes.
Hollingsworth
John M
JM
Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan 48109-0604, USA. kinks@med.umich.edu
Wei
John T
JT
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage*; D042944:Cholestenone 5 alpha-Reductase / Q000037:antagonists & inhibitors*; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000150:complications; D053448:Prostatism / Q000188:drug therapy* / Q000209:etiology
D000317:Adrenergic alpha-Antagonists; D042944:Cholestenone 5 alpha-Reductase