title: Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms.
abstract: BACKGROUND
  Several drugs are approved for the treatment of lower urinary tract symptoms (LUTS) in men, but these are mostly used by clinicians as monotherapies. The combination of different compounds, each of which targets a different aspect of LUTS, seems appealing. However, only few clinical trials have evaluated the effects of combination therapies.
  
  
  OBJECTIVE
  This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS.
  
  
  METHODS
  PubMed and Cochrane databases were used to identify clinical trials and meta-analyses on male LUTS combination therapy. The search was restricted to studies of level of evidence ≥ 1b. A total of 49 papers published between January 1988 and March 2012 were identified.
  
  
  RESULTS
  The α1-adrenoceptor antagonist (α1-blocker)/5α-reductase inhibitor (5-ARI) combination provides the most data. This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for >1 yr; when given for <1 yr, α1-blockers alone are just as effective. The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events. It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after >6 yr. The α1-blocker/muscarinic receptor antagonist (antimuscarinic) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy. Inconsistent data derive from heterogeneous study populations and different study designs. Currently, the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy. The combination seems to be safe in men with postvoid residual <200 ml. However, there are no trials >4 mo concerning safety and efficacy of this combination. The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports. More studies are needed before definitive conclusions can be drawn.
  
  
  CONCLUSIONS
  An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for >1 yr. Based on short-term follow-up studies, add-on of antimuscarinics to α1-blockers is an option when postvoid residual is <200 ml.
authors: Department of Urology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors: Claudius
authors: C
authors: Füllhase
authors: Christopher
authors: C
authors: Chapple
authors: Jean-Nicolas
authors: JN
authors: Cornu
authors: Cosimo
authors: C
authors: De Nunzio
authors: Christian
authors: C
authors: Gratzke
authors: Steven A
authors: SA
authors: Kaplan
authors: Michael
authors: M
authors: Marberger
authors: Francesco
authors: F
authors: Montorsi
authors: Giacomo
authors: G
authors: Novara
authors: Matthias
authors: M
authors: Oelke
authors: Hartmut
authors: H
authors: Porst
authors: Claus
authors: C
authors: Roehrborn
authors: Christian
authors: C
authors: Stief
authors: Kevin T
authors: KT
authors: McVary
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058891:5-alpha Reductase Inhibitors; D058668:Adrenergic alpha-1 Receptor Antagonists; D018727:Muscarinic Antagonists; D058986:Phosphodiesterase 5 Inhibitors
keywords: 5α-reductase inhibitors; Adrenergic α(1)-receptor antagonists; Lower urinary tract symptoms; Muscarinic antagonists; Prostatic hyperplasia