title: Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: results of a systematic literature review and international consensus validation process (LUTS-FORTA 2014).
abstract: OBJECTIVE
  we aimed to systematically review drugs to treat lower urinary tract symptoms (LUTS) regularly used in older persons to classify appropriate and inappropriate drugs based on efficacy, safety and tolerability by using the Fit fOR The Aged (FORTA) classification.
  
  
  METHODS
  to evaluate the efficacy, safety and tolerability of drugs used for treatment of LUTS in older persons, a systematic review was performed. Papers on clinical trials and summaries of individual product characteristics were analysed regarding efficacy and safety in older persons (≥65 years). The most frequently used drugs were selected based on current prescription data. An interdisciplinary international expert panel assessed the drugs in a Delphi process.
  
  
  RESULTS
  for the 16 drugs included here, a total of 896 citations were identified; of those, only 25 reported clinical trials with explicit data on, or solely performed in older people, underlining the lack of evidence in older people for drug treatment of LUTS. No drug was rated at the FORTA-A-level (indispensable). Only three were assigned to FORTA B (beneficial): dutasteride, fesoterodine and finasteride. The majority was rated FORTA C (questionable): darifenacin, mirabegron, extended release oxybutynin, silodosin, solifenacin, tadalafil, tamsulosin, tolterodine and trospium. FORTA D (avoid) was assigned to alfuzosin, doxazosin, immediate release oxybutynin, propiverine and terazosin.
  
  
  CONCLUSIONS
  dutasteride, fesoterodine and finasteride were classified as beneficial in older persons or frail elderly people (FORTA B). For most drugs, in particular those from the group of α-blockers and antimuscarinics, use in this group seems questionable (FORTA C) or should be avoided (FORTA D).
authors.affiliation: Department of Urology, Hannover Medical School, Hannover, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Oelke
authors.affiliation: Department of Geriatrics and Early Rehabilitation, Helios Hanseklinikum, Stralsund, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Becher
authors.affiliation: Department of Urology, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Castro-Diaz
authors.affiliation: Department of Urology, Pitié- Salpêtrière Academic Hospital, Pierre and Marie Curie Medical School, University Paris 6, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
authors.affiliation: Faculty of Health and Human Sciences, University of Hertfordshire, Hertfordshire, UK Centre for Research in Primary and Community Care, The Prostate Centre London, London, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Kirby
authors.affiliation: Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wagg
authors.affiliation: Clinical Pharmacology, University of Heidelberg, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wehling
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000008:administration & dosage; D000284:Administration, Oral; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage; D000367:Age Factors; D000368:Aged; D000375:Aging; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D018727:Muscarinic Antagonists / Q000008:administration & dosage; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D064804:Urological Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists; D018727:Muscarinic Antagonists; D064804:Urological Agents
keywords: 5α-reductase inhibitors; adrenergic α blockers; adrenergic β-3 agonists; antimuscarinics; effectiveness; elderly; lower urinary tract symptoms; older people; phosphodiesterase 5 inhibitors; systematic review; tolerability