title: Comparative Effectiveness and Safety of Monodrug Therapies for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Network Meta-analysis.
abstract: A wide array of drugs are available for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH), but the evidence for the comparative effectiveness is controversial.The objective of this study is to evaluate the comparative effectiveness and safety of monodrug therapies for BPH.Data sources are MEDLINE, EMBASE, and the Cochrane Library.We included randomized controlled trials that compared α-blockers, 5-alpha reductase inhibitors (5ARIs), muscarinic receptor antagonists (MRAs), phosphodiesterase-5 inhibitor (PDE5-Is), or placebo for the treatment of BPH.Comparative effectiveness and safety were pooled by both traditional meta-analysis and network meta-analysis. Summary effect size was calculated as mean difference (MD) and relative risk (RR), together with the 95% confidence intervals (CIs).This study included 58,548 participants from 124 trials in total. When compared with placebo, α-blockers, 5ARIs, and PDE5-Is reduced International Prostate Symptom Score (IPSS) by -1.35 to -3.67 points and increased peak urinary flow rate (PUF) by -0.02 to 1.95 mL/s, with doxazosin (IPSS: MD, -3.67[-4.33 to -3.02]; PUF: MD, 1.95[1.61 to 2.30]) and terazosin (IPSS: MD, -3.37 [-4.24 to -2.50]; PUF: MD, 1.21[0.74 to 1.66]) showing the greatest improvement. The improvement in the IPSS was comparable among tamsulosin, alfuzosin, naftopidil, silodosin, dutasteride, sildenafil, vardenafil, and tadalafil. The incidence of total adverse events and withdraws due to adverse events were generally comparable among various agents.In conclusion, α-blockers, 5ARIs, and PDE5-Is are effective for BPH, with doxazosin and terazosin appearing to be the most effective agents. Drug therapies for BPH are generally safe and well-tolerated, with no major difference regarding the overall safety profile.
authors.affiliation: From the Division of Epidemiology, School of Public Health and Primary Care (JY, CM, ZY, XF, JT); Department of Community and Family Medicine, The Chinese University of Hong Kong (SW); Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, Guangdong Province (JY, CM, ZY, XF, JT); and Kidney Internal Medical Department, Mianyang Central Hospital, Mianyang, China (XD).
authors.forename: Jin-Qiu
authors.initials: JQ
authors.lastname: Yuan
authors.forename: Chen
authors.initials: C
authors.lastname: Mao
authors.forename: Samuel Yeung-Shan
authors.initials: SY
authors.lastname: Wong
authors.forename: Zu-Yao
authors.initials: ZY
authors.lastname: Yang
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Fu
authors.forename: Xiao-Yu
authors.initials: XY
authors.lastname: Dai
authors.forename: Jin-Ling
authors.initials: JL
authors.lastname: Tang
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D058986:Phosphodiesterase 5 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014554:Urination / Q000187:drug effects
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists; D018727:Muscarinic Antagonists; D058986:Phosphodiesterase 5 Inhibitors