Objective: To assess whether the α1-adrenoceptor antagonists currently available for the treatment of lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) (alfuzosin, terazosin, doxazosin and tamsulosin) can be distinguished with regard to clinical efficacy and/or tolerability. Methods: Up-to-date analysis of clinical placebo-controlled or direct comparative studies with α1-adrenoceptor antagonists in patients with LUTS suggestive of BPO derived from a MEDLINE search in October 1998. All retrieved studies were analyzed with regard to efficacy and tolerability. Efficacy was evaluated by the percentage improvement in total symptom score and Qmax (mean end of study value relative to mean baseline value). Tolerability was evaluated by means of study withdrawal rate because of adverse events and the incidence of vasodilatatory adverse events (e.g. dizziness and orthostatic hypotension). Results: Indirect comparison of data derived from the placebo-controlled studies involving 6,333 patients and the data derived from the direct comparative studies involving 507 patients demonstrate that all α1-adrenoceptor antagonists (alfuzosin, terazosin, doxazosin and tamsulosin) produce comparable improvements in LUTS and urinary flow. Total symptom score is in general improved by 30–40% and Qmax by 16–25%. The difference between currently available α1-adrenoceptor antagonists is related to their side effect profile. Alfuzosin (especially the sustained release formulation) and tamsulosin (modified release formulation 0.4 mg) seem to be better tolerated than terazosin and doxazosin. The percentage of patients that withdrew due to bothersome side effects with alfuzosin and tamsulosin 0.4 mg was comparable to that with placebo (about 4–10%) whereas in the terazosin and doxazosin studies an additional 4–10% of patients dropped out because they did not tolerate the therapy. Tamsulosin has less effect on blood pressure than alfuzosin (especially in elderly patients) and causes less symptomatic orthostatic hypotension during orthostatic stress testing than terazosin. Conclusions: All α1-adrenoceptor antagonists seem to have similar efficacy in improving symptoms and flow. The difference between α1-adrenoceptor antagonists is related to their side effect profile. Alfuzosin and tamsulosin appear to be better tolerated than doxazosin, terazosin and prazosin.
I would like to commend the authors on this extensive review which updates previous publications on the subject with reference to papers over the last year. It is extremely encouraging to see that a fresh review of the subject by a new worker in the field reaches similar conclusions to those published previously. It is clear that the future lies in drugs with the lowest possible side effect profile which do not require dose titration and indeed with the minimum number of doses necessary over a 24-hour period. It is of interest that there is an increasing trend towards publication comparing existing agents as detailed in table 2. Not surprisingly there has been considerable controversy in the recent past over the relative merits of these publications based on factors such as numbers of patients, dosages of each drug selected and outcome measures. More definitive answers as to the comparative efficacy of agents although they can be alluded to from meta analyses such as this will require head-to-head comparisons of drugs in adequately powered studies over prolonged periods of time in pragmatic clinical studies of patient groups which more accurately reflect the patient population being treated in general clinical urological practice.
Bob Djavan, MD, PhD
University of Vienna, Department of Urology
Währinger Gürtel 18–20
A–1090 Vienna (Austria)
Tel. +43 1 404002616, Fax +43 1 4089966, E-Mail firstname.lastname@example.org
Number of Print Pages : 13
Number of Figures : 9, Number of Tables : 2, Number of References : 64
Official Organ of the European Association of Urology
Vol. 36, No. 1, Year 1999 (Cover Date: July 1999)
Journal Editor: C.C. Schulman, Brussels
ISSN: 0302–2838 (print), 1421–993X (Online)
For additional information: http://www.karger.ch/journals/eur
Article / Publication Details
Published online: 6/4/1999
Issue release date: July 1999
Number of Print Pages: 13
Number of Figures: 9
Number of Tables: 2
ISSN: 0302-2838 (Print)
eISSN: 1421-993X (Online)
For additional information: http://www.karger.com/EUR
Copyright / Drug Dosage
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.