Safety and Efficacy of Alfuzosin in Men with BPH/LUTS

16 Feb, 22

Introduction

Benign prostatic hyperplasia (BPH) can cause bothersome lower urinary tract symptoms (LUTS) including storage, voiding, post-micturition symptoms, adversely affecting the patient’s quality of life (QoL). Several ?-1 blockers have been used in clinical practice for the treatment of BPH/LUTS in adult males.

Aim

The pharmacokinetic and pharmacodynamic parameters of alfuzosin have been analyzed in this systematic review, and its clinical efficacy both as monotherapy and in combination with other drugs for the treatment of male LUTS/BPH has been evaluated.

Method

Study Design

Systematic review

Treatment Strategy

A systematic review of the last 10 years was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
Extensive literature search was done using the MEDLINE, Scopus, Web of Science, EMBASE and Cochrane databases.
Randomized clinical trials and cohort prospective studies which included men with BPH/LUTS who underwent treatment with alfuzosin or other ?-blockers or who underwent endoscopic or open or minimally invasive surgery for the removal of prostatic adenoma were eligible for qualitative synthesis.

Results

Alfuzosin is a quinazoline derivative and, although a nonspecific ?1-blocker, exhibits a selective concentration in the prostate compared with plasma in patients with BPH.
The pooled analysis of the data from 3 registration trials revealed that alfuzosin significantly reduced the frequency of micturitions at night.
The 10 mg daily formulation has a three-layered matrix containing the active substance between two inactive coats allowing the drug to release over 20 hours.
Alfuzosin 10 mg was well tolerated with the most common adverse event (AE) related to vasodilation being dizziness/postural dizziness.
Treatment with alfuzosin was associated with a few vasodilatory effects and a low rate of ejaculation disorders as compared to older ?-blockers due to the high uroselectivity of alfuzosin and its preferential concentration at urinary level.
Six randomized clinical trials (RCTs) evaluated efficacy and safety of alfuzosin versus other alpha-blockers ± placebo: three studies compared alfuzosin with tamsulosin, one with doxazosin, and two with silodosin or tamsulosin.
One RCT investigated the clinical outcomes of alfuzosin with finasteride.
Two RCTs that compared alfuzosin with propiverine demonstrated significant improvement in the storage symptom scores with the combination therapy.
The results of RCTs that compared alfuzosin with phosphodiesterase-5 inhibitors showed that the combination therapy might be safe and effective in patients with BPH/LUTS and concomitant erectile dysfunction.

Conclusion

The results of this systematic review revealed that alfuzosin is safe and effective in the treatment of LUTS/BPH, with a lower rate of sexual dysfunction, compared with other alpha-blockers.
Alfuzosin was also safe with low adverse events in case of concomitant antihypertensive therapy and in patients with cardiovascular morbidity.
Alfuzosin was found to be safe and effective in case of combination therapy with antimuscarinic agents and phosphodiesterase-5 inhibitors.

Ther Adv Urol. 2021 Apr 12; 13:1756287221993283. Doi: 10.1177/1756287221993283.