PMID- 31699724
OWN - NLM
STAT- MEDLINE
DCOM- 20201106
LR  - 20231019
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 9
IP  - 11
DP  - 2019 Nov 7
TI  - Discontinuation of alpha-blocker therapy in men with lower urinary tract 
      symptoms: a systematic review and meta-analysis.
PG  - e030405
LID - 10.1136/bmjopen-2019-030405 [doi]
LID - e030405
AB  - OBJECTIVES: We aimed to synthesise the available data for the effect of stopping 
      alpha-blocker therapy among men with lower urinary tract symptoms. The focus was 
      on symptom, uroflowmetry and quality of life outcomes, but we also reviewed the 
      adverse events (AEs) and the number of patients who restarted therapy. DATA 
      SOURCES: We searched MEDLINE/PubMed, EMBASE/Ovid and The Cochrane Central 
      Register of Controlled Trials from inception to May 2018. ELIGIBILITY CRITERIA: 
      We selected studies regardless of study design in which men were treated with an 
      alpha-blocker for at least 3 months and in which the effects of alpha-blocker 
      discontinuation were subsequently studied. Only controlled trials were used for 
      the primary objective. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently 
      extracted data and assessed the risk of bias for the controlled studies only 
      using the Cochrane Collaboration's tool for assessing risk of bias. Data were 
      pooled using random-effects meta-analyses. RESULTS: We identified 10 studies 
      (1081 participants) assessing the primary objective. Six studies (733 
      participants) assessed differences in AEs between continuation and 
      discontinuation, and six studies (501 participants) reported the numbers of 
      subjects that restarted treatment after discontinuation. No studies in primary 
      care were identified. After discontinuing monotherapy, symptom scores increased 
      and peak flow rates decreased at 3 and 6 months, but not at 12 months; however, 
      neither parameter changed when alpha-blockers were stopped during combination 
      therapy. Small differences in post-void residual volumes and quality of life 
      scores were considered clinically irrelevant. We also found that 0%-49% of 
      patients restarted after stopping alpha-blocker therapy and that AEs did not 
      increase with discontinuation. CONCLUSIONS: Discontinuing alpha-blocker 
      monotherapy leads to a worsening compared with continuing therapy. Discontinuing 
      the alpha-blocker after combination therapy had no significant effects on 
      outcomes in either the short or long term. Discontinuation may be appropriate for 
      the frail, elderly or those with concomitant illness or polypharmacy. However, 
      studies in primary care are lacking. PROSPERO REGISTRATION NUMBER: 
      CRD42016032648.
CI  - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published 
      by BMJ.
FAU - van der Worp, Henk
AU  - van der Worp H
AUID- ORCID: 0000-0001-5545-4155
AD  - Department of General Practice and Elderly Care Medicine, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands 
      h.van.der.worp@umcg.nl.
FAU - Jellema, Petra
AU  - Jellema P
AD  - Department of General Practice and Elderly Care Medicine, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
FAU - Hordijk, Ilse
AU  - Hordijk I
AD  - Urology, Isala Hospitals, Zwolle, The Netherlands.
FAU - Lisman-van Leeuwen, Yvonne
AU  - Lisman-van Leeuwen Y
AD  - Department of General Practice and Elderly Care Medicine, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
FAU - Korteschiel, Lisa
AU  - Korteschiel L
AD  - Urology, Isala Hospitals, Zwolle, The Netherlands.
FAU - Steffens, Martijn G
AU  - Steffens MG
AD  - Urology, Isala Hospitals, Zwolle, The Netherlands.
FAU - Blanker, Marco H
AU  - Blanker MH
AUID- ORCID: 0000-0002-1086-8730
AD  - Department of General Practice and Elderly Care Medicine, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20191107
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 0 (Adrenergic alpha-Antagonists)
SB  - IM
MH  - Adrenergic alpha-Antagonists/*therapeutic use
MH  - Humans
MH  - Lower Urinary Tract Symptoms/*drug therapy
MH  - Male
PMC - PMC6858108
OTO - NOTNLM
OT  - alpha-blockers
OT  - discontinuation
OT  - lower urinary tract symptoms
OT  - meta-analysis
COIS- Competing interests: None declared.
EDAT- 2019/11/09 06:00
MHDA- 2020/11/11 06:00
PMCR- 2019/11/07
CRDT- 2019/11/09 06:00
PHST- 2019/11/09 06:00 [entrez]
PHST- 2019/11/09 06:00 [pubmed]
PHST- 2020/11/11 06:00 [medline]
PHST- 2019/11/07 00:00 [pmc-release]
AID - bmjopen-2019-030405 [pii]
AID - 10.1136/bmjopen-2019-030405 [doi]
PST - epublish
SO  - BMJ Open. 2019 Nov 7;9(11):e030405. doi: 10.1136/bmjopen-2019-030405.