PMID- 27717522 OWN - NLM STAT- MEDLINE DCOM- 20180212 LR - 20220410 IS - 1873-7560 (Electronic) IS - 0302-2838 (Print) IS - 0302-2838 (Linking) VI - 71 IP - 4 DP - 2017 Apr TI - Comparative Effectiveness of Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis. PG - 570-581 LID - S0302-2838(16)30667-4 [pii] LID - 10.1016/j.eururo.2016.09.032 [doi] AB - CONTEXT: Alpha-blockers (ABs) and 5-alpha reductase inhibitors have an established role in treating male lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH). Recently, newer drugs have shown promise for this indication. OBJECTIVE: To assess the comparative effectiveness and adverse effects (AEs) of newer drugs to treat LUTS attributed to BPH through a systematic review and meta-analysis. EVIDENCE ACQUISITION: Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and Ovid Embase bibliographic databases (through June 2016) were hand searches for references of relevant studies. Eligible studies included randomized controlled trials published in English of newer ABs, antimuscarinics, a beta-3 adrenoceptor agonist, phosphodiesterase type-5 inhibitors, or combination therapy with one of these medications as an active comparator. Observational studies of the same agents with a duration >/=1 yr that reported AEs were also included. EVIDENCE SYNTHESIS: We synthesized evidence from 43 randomized controlled trials as well as five observational studies. Based on improvement of mean International Prostate Symptom Score and quality of life scores, the effectiveness of the newer ABs was not different from the older ABs (moderate strength of evidence [SOE]), but had more AEs (low SOE). Antimuscarinics/AB combination therapy had similar outcomes as AB monotherapy (all moderate SOE), but often had more AEs. Phosphodiesterase type-5 inhibitors alone or in combination with ABs had similar or inferior outcomes than ABs alone. Evidence was insufficient for the beta-3 adrenoceptor agonist. For all newer agents, the evidence was generally insufficient to assess long-term efficacy, prevention of symptom progression, or AEs. CONCLUSIONS: None of the drugs or drug combinations newly used to treat LUTS attributed to BPH showed outcomes superior to traditional AB treatment. Given the lack of superior outcomes, the studies' short time-horizon, and less assurance of their safety, their current value in treating LUTS attributable to BPH appears low. PATIENT SUMMARY: In this paper, we reviewed the evidence of newer drugs to treat men with urinary problems attributable to an enlarged prostate. We found none of the new drugs to be better but there was more concern about side effects. CI - Copyright (c) 2016 European Association of Urology. All rights reserved. FAU - Dahm, Philipp AU - Dahm P AD - Minneapolis VA Health Care System, Minneapolis, MN, USA. Electronic address: pdahm@umn.edu. FAU - Brasure, Michelle AU - Brasure M AD - Division of Health Policy and Management, University of Minnesota, School of Public Health, Minneapolis, MN, USA. FAU - MacDonald, Roderick AU - MacDonald R AD - Minneapolis VA Health Care System, Minneapolis, MN, USA. FAU - Olson, Carin M AU - Olson CM AD - Division of Health Policy and Management, University of Minnesota, School of Public Health, Minneapolis, MN, USA. FAU - Nelson, Victoria A AU - Nelson VA AD - Division of Health Policy and Management, University of Minnesota, School of Public Health, Minneapolis, MN, USA. FAU - Fink, Howard A AU - Fink HA AD - Geriatric Research Education and Clinical Center, Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA. FAU - Rwabasonga, Bruce AU - Rwabasonga B AD - Division of Health Policy and Management, University of Minnesota, School of Public Health, Minneapolis, MN, USA. FAU - Risk, Michael C AU - Risk MC AD - Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Urology, University of Minnesota, Minneapolis, MN, USA. FAU - Wilt, Timothy J AU - Wilt TJ AD - Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA. LA - eng GR - HHSA290201200016I/HS/AHRQ HHS/United States GR - HHSA290201200016I/Intramural VA/United States PT - Comparative Study PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20161004 PL - Switzerland TA - Eur Urol JT - European urology JID - 7512719 RN - 0 (5-alpha Reductase Inhibitors) RN - 0 (Adrenergic alpha-Antagonists) RN - 0 (Adrenergic beta-3 Receptor Agonists) RN - 0 (Muscarinic Antagonists) RN - 0 (Phosphodiesterase 5 Inhibitors) SB - IM CIN - Eur Urol. 2017 Apr;71(4):582-583. PMID: 27914901 MH - 5-alpha Reductase Inhibitors/*therapeutic use MH - Adrenergic alpha-Antagonists/*therapeutic use MH - Adrenergic beta-3 Receptor Agonists/*therapeutic use MH - Comparative Effectiveness Research MH - Drug Therapy, Combination MH - Humans MH - Lower Urinary Tract Symptoms/*drug therapy/etiology MH - Male MH - Muscarinic Antagonists/*therapeutic use MH - Phosphodiesterase 5 Inhibitors/*therapeutic use MH - Prostatic Hyperplasia/complications/*drug therapy MH - Treatment Outcome PMC - PMC5337128 MID - NIHMS821736 OTO - NOTNLM OT - 5-alpha reductase inhibitor OT - Alpha blockers OT - Benign prostatic hyperplasia OT - Comparative effectiveness OT - Lower urinary tract symptoms OT - Randomized trials OT - Systematic review COIS- Financial disclosures: Philipp Dahm certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: This project was funded under Contract Number HHSA290201200016I from the Agency for Healthcare Research and Quality, US Department of Health and Human Services. The authors of this manuscript are responsible for its content. Statements in the manuscript should not be construed as endorsement by the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. The Agency for Healthcare Research and Quality retains a license to display, reproduce, and distribute the data and the report from which this manuscript was derived under the terms of the agency's contract with the author. EDAT- 2016/10/09 06:00 MHDA- 2018/02/13 06:00 PMCR- 2018/04/01 CRDT- 2016/10/09 06:00 PHST- 2016/05/30 00:00 [received] PHST- 2016/09/16 00:00 [accepted] PHST- 2016/10/09 06:00 [pubmed] PHST- 2018/02/13 06:00 [medline] PHST- 2016/10/09 06:00 [entrez] PHST- 2018/04/01 00:00 [pmc-release] AID - S0302-2838(16)30667-4 [pii] AID - 10.1016/j.eururo.2016.09.032 [doi] PST - ppublish SO - Eur Urol. 2017 Apr;71(4):570-581. doi: 10.1016/j.eururo.2016.09.032. Epub 2016 Oct 4.