A combination of drugs reduces lower urinary tract symptoms in men

Fullhase C, Chapple C, Cornu JN, et al. Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms. Eur Urol. 2013;64:228-43.

Review question

Does a combination of drugs reduce lower urinary tract symptoms in men better than one drug alone?

Background

Lower urinary tract symptoms include the need to urinate (“pee” or “pass water”) more often than usual or right away, to urinate often at night, difficulty urinating, pain when urinating, and difficulty stopping urinating. These symptoms often occur in men with enlarged prostates and become more common as men get older.

Different drugs can be used to treat lower urinary tract symptoms. Combining different drugs might be better than any single drug alone for treating these symptoms.

How the review was done

The researchers did a systematic review, searching for studies that were published up to March 2012. They found 15 randomized controlled trials. The most consistent results came from 5 trials.

The trials included more than 9,600 men, with an average age of 62 to 66 years.

A combination of alpha-blockers plus 5-alpha reductase inhibitors was compared with either drug alone or with placebo. Examples of alpha-blockers include terazosin (Hytrin®), alfuzosin (Uroxatral®), doxazosin (Cardura®), and tamsulosin (Flomax ®). Examples of 5-alpha reductase inhibitors are finasteride (Propecia® or Proscar®) and dutasteride (Avodart®).

The trials looked at effects on lower urinary tract symptoms for up to 1 year or for longer periods (2 to 6 years).

What the researchers found

After 6 months to 1 year, a combination of alpha-blockers plus 5-alpha-reductase inhibitors:

• reduced symptoms more than placebo;
• reduced symptoms more than 5-alpha reductase inhibitors alone; but
• did not reduce symptoms more than alpha-blockers alone.

After 2 to 6 years, a combination of alpha-blockers plus 5-alpha reductase inhibitors reduced symptoms more than:

• placebo;
• 5-alpha reductase inhibitors alone; and
• alpha-blockers alone.

Conclusions

In men with lower urinary tract symptoms, a combination of alpha-blockers plus 5-alpha reductase inhibitors reduces short-term symptoms more than 5-alpha reductase inhibitors alone. It also reduces long-term symptoms more than either drug alone.

Combination of alpha-blockers plus 5-alpha reductase inhibitors vs control treatment for lower urinary tract symptoms in men