Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms: Updated meta-analysis

Hyun Jung Kim; Hwa Yeon Sun; Hoon Choi; Jae Young Park; Jae Hyun Bae; Seung Whan Doo; Won Jae Yang; Yun Seob Song; Young Myoung Ko; Jae Heon Kim

doi:10.1371/journal.pone.0169248

Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms: Updated meta-analysis

Hyun Jung Kim, Hwa Yeon Sun, Hoon Choi, Jae Young Park, Jae Hyun Bae, Seung Whan Doo, Won Jae Yang, Yun Seob Song, Young Myoung Ko, Jae Heon Kim

Research output: Contribution to journal › Article › peer-review

25 Citations (Scopus)

Abstract

Background: There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) Objective: The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis. Methods: We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). Results: In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 -0.07), 0.00 (95% CI: -0.08-0.08), and 0.56 (95% CI: 0.23-0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR. Conclusions: Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function.

Original language	English
Article number	e0169248
Journal	PloS one
Volume	12
Issue number	1
DOIs	https://doi.org/10.1371/journal.pone.0169248
Publication status	Published - 2017 Jan
Externally published	Yes

Bibliographical note

Funding Information:
This study was supported by Astellas Pharma Korea, Inc. and Soonchunhyang University Research Fund, Republic of Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Funding Information:
This study was partly supported by Astellas Pharma Korea, Inc. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Publisher Copyright:
© 2017 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Kim, H. J., Sun, H. Y., Choi, H., Park, J. Y., Bae, J. H., Doo, S. W., Yang, W. J., Song, Y. S., Ko, Y. M., & Kim, J. H. (2017). Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms: Updated meta-analysis. PloS one, 12(1), Article e0169248. https://doi.org/10.1371/journal.pone.0169248

Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms: Updated meta-analysis. / Kim, Hyun Jung; Sun, Hwa Yeon; Choi, Hoon et al.
In: PloS one, Vol. 12, No. 1, e0169248, 01.2017.

Research output: Contribution to journal › Article › peer-review

Kim, HJ, Sun, HY, Choi, H, Park, JY, Bae, JH, Doo, SW, Yang, WJ, Song, YS, Ko, YM & Kim, JH 2017, 'Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms: Updated meta-analysis', PloS one, vol. 12, no. 1, e0169248. https://doi.org/10.1371/journal.pone.0169248

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title = "Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms: Updated meta-analysis",

abstract = "Background: There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) Objective: The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis. Methods: We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). Results: In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 -0.07), 0.00 (95% CI: -0.08-0.08), and 0.56 (95% CI: 0.23-0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR. Conclusions: Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function.",

author = "Kim, {Hyun Jung} and Sun, {Hwa Yeon} and Hoon Choi and Park, {Jae Young} and Bae, {Jae Hyun} and Doo, {Seung Whan} and Yang, {Won Jae} and Song, {Yun Seob} and Ko, {Young Myoung} and Kim, {Jae Heon}",

note = "Funding Information: This study was supported by Astellas Pharma Korea, Inc. and Soonchunhyang University Research Fund, Republic of Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: This study was partly supported by Astellas Pharma Korea, Inc. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors. Publisher Copyright: {\textcopyright} 2017 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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T1 - Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms

T2 - Updated meta-analysis

AU - Kim, Hyun Jung

AU - Sun, Hwa Yeon

AU - Choi, Hoon

AU - Park, Jae Young

AU - Bae, Jae Hyun

AU - Doo, Seung Whan

AU - Yang, Won Jae

AU - Song, Yun Seob

AU - Ko, Young Myoung

AU - Kim, Jae Heon

N1 - Funding Information: This study was supported by Astellas Pharma Korea, Inc. and Soonchunhyang University Research Fund, Republic of Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: This study was partly supported by Astellas Pharma Korea, Inc. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors. Publisher Copyright: © 2017 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2017/1

Y1 - 2017/1

N2 - Background: There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) Objective: The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis. Methods: We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). Results: In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 -0.07), 0.00 (95% CI: -0.08-0.08), and 0.56 (95% CI: 0.23-0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR. Conclusions: Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function.

AB - Background: There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) Objective: The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis. Methods: We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). Results: In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 -0.07), 0.00 (95% CI: -0.08-0.08), and 0.56 (95% CI: 0.23-0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR. Conclusions: Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function.

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Efficacy and safety of initial combination treatment of an alpha blocker with an anticholinergic medication in benign prostatic hyperplasia patients with lower urinary tract symptoms: Updated meta-analysis

Abstract

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