Clinical Question:
Do doxazosin and finasteride decrease the risk of clinical progression of
BPH than either drug alone in patients with Lower Urinary Tract Symptoms (LUTS)?
Bottom Line:
Combination therapy with doxazosin and finasteride led to a greater decrease
in the risk of clinical progression of BPH than either drug alone in
patients with LUTS with a baseline TPV of 25 ml or greater.
Reference:
Combination therapy with doxazosin and finasteride for benign prostatic
hyperplasia in patients with lower urinary tract symptoms and a baseline
total prostate volume of 25 ml or greater.Kaplan SA, McConnell JD, Roehrborn
CG, Meehan AG, Lee MW, Noble WR, Kusek JW, Nyberg LM Jr; Medical Therapy of
Prostatic Symptoms (MTOPS) Research Group.J Urol. 2006 Jan;175(1):217-20;
discussion 220-1.
Study Design:
Randomized Controlled Trial
Synopsis:
We examined data from the Medical Therapy of Prostatic Symptoms trial to
determine the relationship between baseline TPV and the effect of medical
therapy in men with LUTS secondary to BPH. A total of 3,047 patients with
LUTS were randomized to placebo, 4 to 8 mg doxazosin, 5 mg finasteride or
the combination of doxazosin and finasteride. Average treatment duration was
4.5 years The primary outcome was time to overall clinical progression of
BPH, defined as a confirmed 4 point or greater increase in AUA SS, acute
urinary retention, incontinence, renal insufficiency or recurrent urinary
tract infection. Secondary outcomes were the need for invasive therapy for
BPH, and changes in AUA SS and the maximum urinary flow rate with time. TPV
was measured by transrectal ultrasound at baseline and study end. In
patients with a small prostate (baseline TPV less than 25 ml) combination
therapy was no better than doxazosin alone for decreasing the risk of
clinical progression of BPH and need for invasive therapy as well as
improving AUA SS and the maximum urinary flow rate. However, in patients
with moderate size (25 to less than 40 ml) or enlarged (40 ml or greater)
glands combination therapy led to a clinical benefit in these outcomes that
was superior to that of doxazosin or finasteride. |