Simultaneous use of alpha-blockers and anticholinergics is a better way to treat those with Benign Prostatic Hyperplasia (BPH) and lower urinary tract symptoms than administering the therapies one after the other, research has confirmed.
The study, “Efficacy and Safety of Initial Combination Treatment of an Alpha Blocker with an Anticholinergic Medication in Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptoms: Updated Meta-Analysis,” was published in the open-access journal PLOS One.
Researchers wanted to see whether combining alpha-blockers with anticholinergics as an initial therapy for enlarged prostate was more effective than administering alpha blockers first, then adding anticholinergics — a process known as add-on therapy.
Alpha-blockers are a large family of therapies that block α1-adrenergic receptors in arteries, smooth muscles, and central nervous system tissues. Anticholinergics block the neurotransmitter acetylcholine.
Researchers used meta-analysis — a statistical procedure that combines data from multiple studies — and a review of previous research to measure the effectiveness and safety of the combined versus ad-on approaches.
The team included both randomized and non-randomized controlled clinical trials of BPH patients in their analysis. The studies dealt with such measures of BPH as International Prostate Symptom Score, or IPPS; a score on urine remaining in the kidney, known as storage IPSS; a quality of life score; maximum flow rate, or Qmax; post-void residual urine level, or PVR; and acute urinary retention level, or AUR.
Researchers looked for studies dealing with the alpha-blockers tamsulosin, terazosin, doxazosin, alfuzocin, naftopidil, and silodosin, They also looked for research dealing with the anticholinergics solifenacin, tolterodine, fesoterodine, propiverine, oxybutinin, tropium sodium, and darifenacin.
The meta-analysis included studies covering 3,548 trial participants — 2,195 with BPH and 1,353 controls. All studies were published before April 2016.
Simultaneous administration of alpha-blockers and anticholinergic agents was more effective for treating BPH patients with lower urinary tract symptoms than an ad-on approach, the analysis suggested.
Researchers noted that the simultaneous-therapy approach produced particularly good results in the storage-symptom and quality-of-life categories. The results came without increasing patients’ risk of more adverse events, especially in patients with lower-urinary-tract or overactive-bladder symptoms. Overactive bladder is a sudden urge to urinate stemming from bladder-storage problems.