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Anticholinergic plus alpha-blocker of ‘uncertain’ benefit in men with urinary problems

Cochrane Database of Systematic Reviews
Reuters Health - 25/02/2021 - For men with lower-urinary-tract symptoms (LUTS) due to benign prostatic obstruction, combining an anticholinergic with an alpha-blocker has "little or uncertain" effect on urinary symptoms, according to a new Cochrane review.

LUTS due to benign prostatic obstruction (BPO) is common. Alpha-blockers are often first-line therapy, but up to a third of men fail to find relief. Adding an anticholinergic may help improve symptoms, although efficacy is unclear.

To investigate, Dr. Ran Pang, with the China Academy of Chinese Medical Sciences, in Beijing, and colleagues identified 23 studies involving 6,285 men with LUTS due to BPO. The mean age of study participants ranged from 54 to 74 years.

Five studies compared combination therapy with anticholinergics and alpha-blockers versus placebo in 2,369 men. The data showed that combination therapy resulted in "little or no difference" in urologic symptom scores and "uncertain" improvement in quality of life and likely increases in adverse events, the researchers report in the Cochrane Database of Systematic Reviews.

The 22 studies that compared combination therapy with alpha-blocker monotherapy in 4,904 men participants found "uncertain effects on improvement of urinary symptoms and quality of life compared to alpha-blockers alone," although combination therapy might not increase unwanted side effects, they report.

The three studies that compared combination therapy with anticholinergic monotherapy in 1,218 men also showed "uncertain" effects regarding combination therapy on urologic symptoms but suggested an improvement in quality of life compared with anticholinergics alone and without an increase in side effects.

The researchers note that most of the studies were "not well conducted or reported" with only moderate, low or very low certainty of evidence. The findings are also limited by "study limitations, inconsistency, and imprecision" and the inability to conduct any of the predefined subgroup analyses.

"Given the very low- to low-certainty evidence that characterizes most of the reported analyses, there is need for additional research to explore the effectiveness and safety of combination therapy on lower urinary tract symptoms/benign prostatic obstruction," the study team concludes.

"Future trials should be conducted according to higher methodological standards with regards to allocation concealment and blinding to minimize concerns about selection, performance, and detection bias. Furthermore, trials with long-term follow-up are also needed to assess the long-term efficacy and safety of combination therapy," they add.

This research had no commercial funding and the authors have no relevant disclosures.

SOURCE: https://bit.ly/3ux4eTs Cochrane Database of Systematic Reviews, online February 10, 2021.

By Reuters Staff

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