Advertisement

α-Blockers vs. α-Blockers plus Anticholinergics for Benign Prostatic Hyperplasia

Summary and Comment |
January 16, 2014

α-Blockers vs. α-Blockers plus Anticholinergics for Benign Prostatic Hyperplasia

  1. Allan S. Brett, MD

A meta-analysis does not show a convincing advantage for combination therapy.

  1. Allan S. Brett, MD

In patients with benign prostatic hyperplasia (BPH), α-blockers such as tamsulosin and doxazosin work primarily by relieving obstructive symptoms (e.g., incomplete emptying, weak stream). However, many BPH patients also have “storage symptoms” (e.g., frequency, urgency, nocturia) for which anticholinergic drugs such as oxybutynin and tolterodine might be helpful. Researchers conducted this meta-analysis of seven studies (3600 BPH patients) in which α-blocker monotherapy was compared with combination therapy (α-blocker plus anticholinergic agent).

Combination therapy, compared with monotherapy, improved symptoms on a storage subscore of the widely used International Prostate Symptom Score (I-PSS); although the difference was statistically significant, it averaged only 0.7 points on the 15-point subscore. One concern about add-on anticholinergic therapy is a predisposition to acute urinary retention; this occurred significantly more often with combination therapy than with monotherapy (1.4% vs. 0.4%) during 12 weeks of treatment.

Comment

The authors suggest that their findings confirm the efficacy and safety of combined therapy — I disagree. First, they only reported outcomes on the storage subscale of I-PSS; I looked at the publications representing the three largest trials included in this analysis, and add-on anticholinergic therapy did not improve I-PSS total symptom scores (comprising both storage and obstructive symptoms) or quality-of-life scores in any of them. Second, even 1 additional case of acute urinary retention per 100 treated patients is concerning in a 3-month study; what might happen over 1 or 2 years? And, third, the authors don't discuss the nonurinary side effects of anticholinergic drugs in older people. Although combined therapy might be worthwhile for selected individuals, potential benefits do not outweigh potential harms, on average.

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement