Defining the Efficacy and Safety of Phosphodiesterase Type 5 Inhibitors with Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia with or without Erectile Dysfunction: A Network Meta‐Analysis

Ma, Chengquan; Zhang, Jianzhong; Cai, Zhonglin; Xiong, Jian; Zhang, Dongliang

doi:10.1155/2020/1419520

Cited by 7 publications

(4 citation statements)

References 42 publications

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“…The order of drug administration does not have any significant effects [ 17 ]. A meta-analysis suggests that sildenafil–tamsulosin is a reliable combination therapy for men with LUTS with/without ED [ 18 ]. Further studies are required to compare tadalafil vs sildenafil in combination with tamsulosin on LUTS improvement.…”

Section: Discussionmentioning

confidence: 99%

Is tadalafil associated with decreased risk of major adverse cardiac events or venous thromboembolism in men with lower urinary tract symptoms?

et al. 2022

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Purpose To evaluate the association of tadalafil, a phosphodiesterase-5 inhibitor (PDE5I), with major adverse cardiac events (MACE) or venous thromboembolism (VTE) in men with lower urinary tract symptoms (LUTS). Methods Data was obtained from the TriNetX Research Network, ICD-10 codes were used to identify men with LUTS, MACE, and VTE. In addition, demographic characteristics and use of tadalafil or alpha-blocker was evaluated. Then, unbalanced and balanced association analyses was performed to assess the relation between tadalafil and/or alpha-blocker use with MACE/VTE. Results After participant selection, analysis included 821,592 men that did not use an alpha blocker or tadalafil, 5,004 men that used tadalafil but no alpha blocker, 327,482 men that used an alpha blocker but no tadalafil, and 6,603 men that used both an alpha blocker and tadalafil. On balanced analysis, tadalafil was independently associated with a decreased risk of MACE/VTE within a 3-year time period (OR = 0.59, 95%CI 0.49–0.70, p < 0.0001). Among men with a history of alpha blocker use, tadalafil use was also independently associated with a decreased risk of MACE or VTE, both before and after controlling for potentially confounding variables (OR = 0.57, 95%CI: 0.50–0.66; p < 0.0001). Conclusions In our study, tadalafil was associated with a decreased risk of MACE/VTE in men with LUTS with and without a history of alpha blocker use. It is time to perform further long-term prospective randomized studies to further analyze the cardiovascular effects of PDE5Is as combination treatment with alpha blockers in the management of LUTS. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04005-3.

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Section: Discussionmentioning

confidence: 99%

Is tadalafil associated with decreased risk of major adverse cardiac events or venous thromboembolism in men with lower urinary tract symptoms?

et al. 2022

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“…Men with detrusor hyperactivity respond better to combination treatment with α-blocker with an anticholinergic rather than monotherapy [ 7 ]. Combination treatment also makes use of PDE5 inhibitors (even in the absence of erectile dysfunction)[ 8 ] and 5 ARIs for larger gland sizes. Nevertheless, a significant proportion of these patients do not respond to the first-line medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Predictors of Response to Tamsulosin for Benign Prostatic Obstruction

Shoaib

Bangash

Aziz

et al. 2021

Cureus

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To identify non-invasive predictors of response to tamsulosin 0.4 mg in patients with benign prostatic obstruction (BPO). Methods Males ≥ 50 years of age with lower urinary tract symptoms (LUTS) suggestive of BPO for over three months were included in the study. We assessed change in the mean International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) after six weeks of medical therapy. Clinical and uroflowmetry parameters were compared between two groups of patients with >25% vs. <25% change in the IPSS after treatment. Preand post-treatment post-void residue (PVR), Qmax, and IPSS were compared by independent t-test, univariate/multivariate regression analysis. Results A total of 121 patients were included. At presentation, the mean prostate size was 35.7±12.2 grams and the mean IPSS was 16.3 ± 4.8. Improvement in the mean IPSS was 7.83, with more marked improvement in storage compared to voiding LUTS (5.26 vs. 2.57). Majority (58%) had a quality of life (QoL) score of 4-5 at presentation whereas after 6-weeks of medication (83.5%) had a QoL score of 0-2. Treatment failure was noted in 11 (9.1%) patients. IPSS was higher and Qmax was lower at the time of presentation in patients who had <25% improvement. However, the two groups were identical on the basis of demographic and other factors (BMI, age, prostate size, PVR). Conclusion Moderate LUTS secondary to BPO responds favourably to alpha-blocker (tamsulosin 0.4 mg) treatment. Uroflowmetry (UFM) parameters, that is, Qmax and IPSS are important factors in predicting short-term response to medical therapy.

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“…Another previous meta-analysis comparing combination therapy with α-blockers and PDE5Is with monotherapy suggested that combination therapy improved LUTS. [ 7 ] Previous NMAs [ 29 , 30 ] comparing phosphodiesterase type 5 inhibitors combined with tamsulosin among the general population suggested that sildenafil combined with tamsulosin is superior to other administrations. In our study, however, sildenafil (25 mg) combined with α-blockers is not proven to be superior to other administrations.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerability of combination therapy with alpha-blockers and phosphodiesterase-5 inhibitors compared with monotherapy for lower urinary tract symptoms

et al. 2020

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Purpose: This study aimed to compare the efficacy and safety of combination therapy consisting of α-blockers and different phosphodiesterase type 5 inhibitors for lower urinary tract symptoms (LUTS) by performing a network meta-analysis. Method: Relevant articles were retrieved from the Cochrane Library, PubMed, and EMBASE databases. Bayesian network meta-analyses were performed with a random-effect model to compare the efficacy and safety of combination therapy with α-blockers and phosphodiesterase-5 inhibitors for LUTS. The odds ratio (OR), mean difference (MD) and surface under the cumulative ranking curve (SUCRA) were calculated with the GeMTC R package. Results: Twenty randomized trials with 4131 patients were included in this network meta-analysis. Based on the SUCRA values, vardenafil (10 mg) combined with α-blockers ranked first, first and sixth; sildenafil (25 mg) combined with α-blockers ranked second, third and first; and tadalafil (20 mg) combined with α-blockers ranked third, second and fourth in IPSS, post void residual, and maximum flow rate, respectively. Conclusions: Combination therapy with α-blockers and phosphodiesterase-5 inhibitors was effective and well tolerated for LUTS. For men who prioritize high efficacy, vardenafil (10 mg) combined with α-blockers seems to be the treatment of choice. For men wishing to optimize minimally invasive treatment, sildenafil (25 mg) and tadalafil (20 mg) combined with α-blockers appears to have a possible advantage in terms of avoiding adverse effects.

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Defining the Efficacy and Safety of Phosphodiesterase Type 5 Inhibitors with Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia with or without Erectile Dysfunction: A Network Meta‐Analysis

Cited by 7 publications

References 42 publications

Is tadalafil associated with decreased risk of major adverse cardiac events or venous thromboembolism in men with lower urinary tract symptoms?

Is tadalafil associated with decreased risk of major adverse cardiac events or venous thromboembolism in men with lower urinary tract symptoms?

Non-Invasive Predictors of Response to Tamsulosin for Benign Prostatic Obstruction

Efficacy and tolerability of combination therapy with alpha-blockers and phosphodiesterase-5 inhibitors compared with monotherapy for lower urinary tract symptoms

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