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Alpha-1 antagonists for BPH

 

Clinical bottom line

Four alpha blockers seem to be effective, about equally in short term trials. More definitive statements are not possible.


Reference

B Djavan & M Marberger. A meta-analysis on the efficacy and tolerability of alpha1-adrenoreceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. European Urology 1999 36: 1-13.

Review

This MEDLINE search up to October 1998 included only English language papers that were fully published, and for alfuzosin, terazocin, doxazocin and tamsulosin. For inclusion placebo and active controlled trials were accepted in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. There is no specific comment on trial design (randomised, double-blind) or trial quality. This is assumed.

A variety of doses for each of the four treatments was used, and trial duration was from 1-12 months, with a median of about three months. Information was reported on a variety of outcomes.

Results

The paper reports the percentage of men given treatment or placebo with particular outcomes (efficacious or harmful), but makes little or no attempt to combine them in any meaningful way. This is a shame, because information on over 6,000 men in these trials. There is a statement all four drugs produce about equal effects (but at what dose?) in terms of symptoms and urinary flow. Total symptom score is said to be improved by 30-40% and maximum flow rate by 16-25%.

Comment

A useful paper in terms of identifying trials, but not at all in looking at issues of quality of validity, and relating outcomes to wither these or dose of drug.