Introduction

Most of the men with benign prostatic hyperplasia (BPH) experience irritative and obstructive lower urinary tract symptoms (LUTS), disrupting the daily activities and sleep. One of the primary intent of BPH treatment is to alleviate these troublesome symptoms. Medical therapy for BPH comprises various drugs, however, alpha(α)-blockers are considered as the first-line drugs for treating BPH. Despite several clinical trials have evaluated the efficacy of α-blockers for BPH, there is paucity of direct comparisons among these drugs. There is no network meta-analysis that has compared the treatment outcomes and safety of these drugs.

Aim

This network meta-analysis (NMA) compares the efficacy and safety of α-blockers in the management of BPH based on the available randomized controlled trials (RCTs).

Method

Study Design

• Network meta-analysis of randomized clinical trials

Treatment Strategy

• Eligible RCTs were identified after an extensive electronic search of PubMed, Embase, Ovid MEDLINE, and Cochrane Library databases
• The RCTs evaluated the efficacy and safety of α-blocker in men aged >45 years with LUTS related to BPH 

  Endpoints

• International prostate symptom score (IPSS)
• Maximum flow rate (Qmax)
• Quality of life (QoL)
• Post-void residual volume (PVR)
• Treatment-emergent adverse events (TEAEs)

Results

• This NMA included 22 studies covering 3371 patients
• The RCTs used six kinds of α-blockers with 12 dose categories
• Mean age of patients was 65.3 years
• IPSS was significantly reduced with tamsulosin 0.4 mg, naftopidil 50 mg and silodosin 8 mg as compared to the placebo
• Based on the p-score, the highest-ranked treatment was tamsulosin 0.4 mg and the lowest-ranked treatment was doxazosin 2 mg
• Tamsulosin 0.4 mg and naftopidil 50 mg had the highest probability of improving PVR, with a p-score 0.89
• Tamsulosin 0.4 mg had the highest probability of improving Qmax with a p-score of 0.75
• Doxazosin 8 mg had the highest probability of improving QoL
• A total of 297 adverse events were reported among all the α-blockers, silodosin was associated with a notable number of TEAEs
• The most common AEs were ejaculation dysfunction, dizziness and hypotension

Conclusion

• All the included α-blockers resulted in significant reduction in the International Prostate Symptom Score (IPSS), however, tamsulosin outperformed the other α-blocker monotherapies with respect to IPSS, maximum flow rate and post-void residual volume in men with lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH).
• Silodosin was associated with a notable number of adverse events.

Sci Rep. 2024 May 15;14(1):11116. Doi: 10.1038/s41598-024-61977-5.