Meta-analysis: combination therapy is better for reducing BPH symptoms

  • Zhou Z & al.
  • BMC Urol
  • 11 Mar 2019

  • International Clinical Digest
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Takeaway

  • Combination therapy with tamsulosin (Flomax) and dutasteride (Avodart) is more effective than tamsulosin alone for reducing progression of benign prostatic hyperplasia (BPH) symptoms and acute urinary retention.

Why this matters

  • This analysis could inform decisions for treating BPH.

Study design

  • Researchers analyzed 5 randomized controlled trials comparing BPH treatment with a combination of tamsulosin and dutasteride vs tamsulosin alone (N=4348).
  • Funding: None.

Key results

  • Combination therapy significantly reduced risk for (ORs, 95% CIs):
    • BPH symptom progression: 0.56 (0.46-0.67; P<.00001>
    • Acute urinary retention: 0.61 (0.38-0.98; P=.04).
  • However, patients undergoing combination therapy also experienced more adverse sexual effects, including (ORs; 95% CIs):
    • erectile dysfunction: 2.24 (1.73-2.92; P<.00001>
    • ejaculation disorder: 3.37 (1.97-5.79; P<.0001>
    • retrograde ejaculation: 2.30 (1.08-4.93; P=.03); 
    • decreased libido: 2.25 (1.53-3.31; P<.0001>
    • loss of libido: 3.38 (1.94-5.88; P<.0001>

Limitations

  • The number of randomized controlled trials available for analysis was small.
  • Trial results did not include data on long-term efficacy and tolerance of combination therapy.

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