Systematic review and meta-analysis on phosphodiesterase 5 inhibitors and α-adrenoceptor antagonists used alone or combined for treatment of LUTS due to BPH

Xing-Huan Wang, Xiao Wang, Ming-Jun Shi, Sheng Li, Tao Liu, Xin-Hua Zhang, Xing-Huan Wang, Xiao Wang, Ming-Jun Shi, Sheng Li, Tao Liu, Xin-Hua Zhang

Abstract

The aim of this systematic review is to determine the comparative effectiveness and safety of phosphodiesterase 5 inhibitors (PDE5-Is) and α-blockers used alone or combined for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). An electronic search of PubMed, Cochrane Library and Embase up to January 2014 was performed to identify randomized controlled trials comparing the efficacy and safety of PDE5-Is and α-blockers for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia, which assessed IPSS score, maximum flow rate, postvoided residual urine, quality of life and Erectile Function (IIEF) score as outcomes. Data were analyzed by fixed or random effect models using Cochrane Collaboration review manager software. A total of 12 studies were included. Our novel data demonstrated that there was a trend that α-blockers were more efficacious than PDE5-Is on decreasing IPSS score and increasing maximum flow rate. α-blockers were significantly more effective than PDE5-Is on reduction of postvoided residual urine with a mean difference of 3.67 (95% CI 1.56 to 5.77, P = 0.0006) and PDE5-Is showed greater effect than α-blockers on increasing IIEF score with a mean difference of 9.82 (95% CI 3.80 to 15.85, P = 0.001). In conclusion, our novel data demonstrated that PDE5-Is plus ABs ranked the highest on the improvement of LUTS/BPH. PDE5-Is monotherapy was also effective in this kind of disorder except less reduction of PVR than ABs. In addition, both combined- or mono-therapy were safe.

Figures

Figure 1
Figure 1
PRISMA flowchart of identification and selection of studies for inclusion in the systematic review.
Figure 2
Figure 2
Forest plot for meta-analysis of efficacy of PDE5-Is versus ABs by assessment of IPSS, Qmax, PVR, QoL and IIEF. (a) Pooled MD of score changes from baseline to treatment endpoint of IPSS; (b) Pooled MD of changes from baseline to treatment endpoint of Qmax; (c) Pooled MD of changes from baseline to treatment endpoint of PVR; (d) Pooled MD of changes from baseline to treatment endpoint of QoL; (e) Pooled MD of score of the IIEF at treatment endpoint. ABs: α-blockers; PDE5-Is: phosphodiesterase 5 inhibitors; Qmax: maximum flow rate; IIEF: international index of erectile function; QoL: quality of life; PVR: postvoided residual urine; MD: mean difference; IPSS: international prostate symptom score.
Figure 3
Figure 3
Forest plot for meta-analysis of efficacy of ABs plus PDE5-Is versus PDE5-Is by assessment of IPSS, Qmax, PVR, QoL and IIEF. (a) Pooled MD of score changes from baseline to treatment endpoint of IPSS; (b) Pooled MD of changes from baseline to treatment endpoint of Qmax; (c) Pooled MD of changes from baseline to treatment endpoint of PVR; (d) Pooled MD of changes from baseline to treatment endpoint of QoL; (e) Pooled MD of score of the IIEF at treatment endpoint. ABs: α-blockers; PDE5-Is: phosphodiesterase 5 inhibitors; Qmax: maximum flow rate; MD: mean difference; IPSS: international prostate symptom score; PVR: postvoided residual urine; QoL: quality of life; IIEF: international index of erectile function.
Figure 4
Figure 4
Forest plot for meta-analysis of efficacy of ABs plus PDE5-Is versus ABs by assessment of IPSS, Qmax, PVR, QoL and IIEF. (a) Pooled MD of score changes from baseline to treatment endpoint of IPSS; (b) Pooled MD of changes from baseline to treatment endpoint of Qmax; (c) Pooled MD of changes from baseline to treatment endpoint of PVR; (d) Pooled MD of changes from baseline to treatment endpoint of QoL; (e) Pooled MD of score of the IIEF at treatment endpoint. ABs: α-blockers; PDE5-Is: phosphodiesterase 5 inhibitors; IPSS: international prostate symptom score; MD: mean difference; PVR: postvoided residual urine; IIEF: international index of erectile function; Qmax: maximum flow rate; QoL: quality of life.
Figure 5
Figure 5
Forest plot for meta-analysis of adverse events of PDE5-Is versus ABs. OR of incidence of any adverse events (a); dizziness (b); dyspepsia (c); headache (d) and nasopharyngitis (e). ABs: α-blockers; PDE5-Is: phosphodiesterase 5 inhibitors; OR: odds ratio.
Figure 6
Figure 6
Rank probabilities of ABs, PDE5-Is and combination therapy as measured by assessment of IPSS, Qmax, PVR, QoL and IIEF. The Bayesian approach could apply the rank probabilities of each drug therapy. Rank probabilities sum to one, both within a rank over treatments and within a treatment over ranks. Rank 1 represented the best efficacy on the reduction of IPSS total score, PVR, QoL and increase of Qmax and IIEF. ABs: α-blockers; PDE5-Is: phosphodiesterase 5 inhibitors; IPSS: international prostate symptom score; Qmax: maximum flow rate; PVR: postvoided residual urine; QoL: quality of life; IIEF: international index of erectile function.

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