Efficacy and safety of Afalaza in men with symptomatic benign prostatic hyperplasia at risk of progression: a multicenter, double-blind, placebo-controlled, randomized clinical trial

Dmitry Pushkar, Andrey Vinarov, Leonid Spivak, Konstantin Kolontarev, Mikhail Putilovskiy, Elena Andrianova, Oleg Epstein, Dmitry Pushkar, Andrey Vinarov, Leonid Spivak, Konstantin Kolontarev, Mikhail Putilovskiy, Elena Andrianova, Oleg Epstein

Abstract

Introduction: In order to investigate the efficacy and safety of Afalaza in men with benign prostatic hyperplasia (BPH) at risk of progression, this multicenter, double-blind, placebo-controlled, randomized clinical trial was performed. Derived by technological treatment of antibodies to prostate-specific antigen (PSA) and endothelial nitric oxide synthase (eNOs), Afalaza was previously proved to modulate its molecular targets. The mechanism of action of the drug is associated with the modulating effect of the antibiodies (RA-Abs) on the molecular targets (PSA and eNOS) by way of conformational changes.

Material and methods: A total of 49 patients aged 45-60 years with BPH and moderate lower urinary tract symptoms (LUTS), total prostate volume (TPV) ≥30 cm3, Qmax 10-15 ml/s, and serum PSA<4 ng/ml were randomly assigned to receive either Afalaza (n = 125) or placebo (n = 124) for 12 months. Changes in BPH/LUTS symptoms (according to the International Prostate Symptom Score), Qmax, TPV, PSA, BPH clinical progression, occurrence of acure urinary retention (AUR) events or BPH-related surgery were estimated as the study endpoints.

Results: IPSS mean change was -3.7 ±3.0 (95% CI -4.3 to -3.2) after 12 months of Afalaza (vs. -2.9 ±2.4; 95% CI -3.3 to -2.4 in placebo; р = 0.02). Qmax growth was 2.5 ±4.3 ml/s (vs. 1.4 ±3.3 in placebo; p = 0.049), TPV reduced by 11.8 ±16.0% (vs. 6.5 ±14.7%; p = 0.01, and PSA remained unchanged. Afalaza therapy resulted in a significant decrease in the total sum of BPH progression symptoms (p = 0.01). The maximum effect of Afalaza was registered after 12 months without a tendency to form a 'plateau'. During the study, no patients experienced AUR or BPH-related surgery.

Conclusions: A 12-month course of Afalaza therapy is effective and safe for patients with BPH. The results of end points measurements revealed asignificant advantage of Afalaza compared to placebo in the overall symptoms benefit and a decline in the risk of BPH progression.ClinicalTrials.gov: NCT01716104.

Keywords: Afalaza; BPH progression symptoms; benign prostatic hyperplasia; released-activity.

Figures

Figure 1
Figure 1
Study design flow diagram.
Figure 2
Figure 2
Mean changes in International Prostate Sypmtom Score (IPSS) score during 12 months.
Figure 3
Figure 3
Mean changes in Qmax during 12 months.
Figure 4
Figure 4
Mean changes in total prostate volume (%) during 12 months.
Figure 5
Figure 5
Mean changes in total sum of the risk factors for BPH progression during 12 months.

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