Comparison of add-on medications for persistent storage symptoms after α-blocker treatment in BPH patients – a network meta-analysis

BMC Urology

Research

Jeremy Yuen-Chun Teoh¹  Wen-Jeng Wu²  Hsiang-Ying Lee²  Yi-Ting Su³  Hsiao-Ling Chen⁴  Vinson Wai-Shun Chan⁵ 

[1] Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China;Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1St Road, Sanmin Dist., 80708, Kaohsiung, Taiwan;Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1St Road, Sanmin Dist., 80708, Kaohsiung, Taiwan;Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1St Road, Sanmin Dist., 80708, Kaohsiung, Taiwan;Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan;Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan;Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK;

关键词: Benign prostatic hyperplasia;    Alpha-blockers;    Storage symptoms;    Add-on medications;    Network meta-analysis;   

DOI  :  10.1186/s12894-023-01327-1

 received in 2023-04-21, accepted in 2023-09-17,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPatients with benign prostatic hyperplasia (BPH) receive α-blockers as first-line therapy to treat lower urinary tract symptoms; however, some individuals still experience residual storage symptoms. Antimuscarinics, β3-agonists, and desmopressin are effective add-on medications. Nevertheless, there is currently no evidence for the appropriate choice of the first add-on medication. This systematic review aimed to investigate the clinical benefits of antimuscarinics, β3-agonists, and desmopressin, in addition to α-blockers, for persistent storage symptoms in BPH patients.MethodsA comprehensive literature search of randomized controlled trials (RCTs) comparing the efficacy of different add-on medications in BPH patients with persistent storage symptoms despite α-blocker treatment was conducted. Clinical outcomes included the International Prostate Symptom Score (IPSS), IPSS storage subscore, nocturia, micturition, and urgency. A network meta-analysis was performed to estimate the effect size. Surface under cumulative ranking curves (SUCRAs) were used to rank the included treatments for each outcome.ResultsA total of 15 RCTs were identified. Add-on imidafenacin and mirabegron resulted in significant improvement in all outcomes assessed. Other add-on medications such as desmopressin, tolterodine, solifenacin, fesoterodine, and propiverine showed positive benefits for most, but not all, outcomes. Based on the SUCRA rankings, add-on desmopressin was the best-ranked treatment for IPSS and nocturia, and add-on imidafenacin was the best for the IPSS storage subscore and micturition.ConclusionsBPH patients presenting with persistent storage symptoms despite α-blocker administration are recommended to include additional treatment. Desmopressin and imidafenacin may be considered high-priority add-on treatments because of their superior efficacy compared with other medications.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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