A Meta-Analysis of Long- Versus Short-Acting Phosphodiesterase 5 Inhibitors: Comparing Combination Use With α-Blockers and α-Blocker Monotherapy for Lower Urinary Tract Symptoms and Erectile Dysfunction
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Combination therapy with an α-1-adrenergic blocker and phosphodiesterase type 5 inhibitors (PDE5Is) has shown improvements in lower urinary tract symptoms (LUTS) with negligible side effects. Nonetheless, decisive advantages in symptom improvement were insufficient, and there were no clinical differences between long- or short-acting PDE5Is in combination with combination medication. Methods: To review the studies on α-1-adrenergic blocker monotherapy and combination therapy with long vs. short-acting PDE5Is in their use in LUTS and erectile dysfunction (ED). A search of the MEDLINE, Embase, Cochrane Library, and KoreaMed databases was conducted from 2000 to 2014 using combinations of the relevant terms. Among the 323 relevant references discovered, 10 were selected for meta-analysis. The data showed that 616 men received combination therapy (PDE5Is with α-1-adrenergic blockers) or α-1-adrenergic blocker monotherapy. Results: Meta-analysis of the combination therapy showed it was more effective than α-blockers in improving symptoms, with a mean International Prostrate Symptom Score change difference of –1.93 while those of the long- vs. short-acting PDE5I were –2.12 vs. –1.70. Compared to maximum flow rate (Qmax) value with monotherapy, the Qmax increased more with the combination therapy (mean difference of 0.71) while change values were 0.14 and 1.13 for the long- and short-acting PDE5Is, respectively. Residual urine decreased more with the combination therapy than it did with α-1-adrenergic blocker monotherapy with a mean difference of –7.09 while the mean residual urine change values for long- vs. short-acting PDE5Is were –18.83 vs. –5.93. The International Index of Erectile Function value increased by 3.99, 2.85, and 4.85 following combination therapy, and therapy with long- and short-acting PDE5Is. Conclusions: Our meta-analysis suggests that PDE5Is can significantly improve LUTS in men with benign prostatic hyperplasia/ ED. Furthermore, combination PDE5I and α-1-adrenergic blocker could be a more effective treatment than α-1- adrenergic blocker monotherapy, and the differences between long and short-acting agents were minimal.
Abstract
Purpose: Combination therapy with an α-1-adrenergic blocker and phosphodiesterase type 5 inhibitors (PDE5Is) has shown improvements in lower urinary tract symptoms (LUTS) with negligible side effects. Nonetheless, decisive advantages in symptom improvement were insufficient, and there were no clinical differences between long- or short-acting PDE5Is in combination with combination medication. Methods: To review the studies on α-1-adrenergic blocker monotherapy and combination therapy with long vs. short-acting PDE5Is in their use in LUTS and erectile dysfunction (ED). A search of the MEDLINE, Embase, Cochrane Library, and KoreaMed databases was conducted from 2000 to 2014 using combinations of the relevant terms. Among the 323 relevant references discovered, 10 were selected for meta-analysis. The data showed that 616 men received combination therapy (PDE5Is with α-1-adrenergic blockers) or α-1-adrenergic blocker monotherapy. Results: Meta-analysis of the combination therapy showed it was more effective than α-blockers in improving symptoms, with a mean International Prostrate Symptom Score change difference of –1.93 while those of the long- vs. short-acting PDE5I were –2.12 vs. –1.70. Compared to maximum flow rate (Qmax) value with monotherapy, the Qmax increased more with the combination therapy (mean difference of 0.71) while change values were 0.14 and 1.13 for the long- and short-acting PDE5Is, respectively. Residual urine decreased more with the combination therapy than it did with α-1-adrenergic blocker monotherapy with a mean difference of –7.09 while the mean residual urine change values for long- vs. short-acting PDE5Is were –18.83 vs. –5.93. The International Index of Erectile Function value increased by 3.99, 2.85, and 4.85 following combination therapy, and therapy with long- and short-acting PDE5Is. Conclusions: Our meta-analysis suggests that PDE5Is can significantly improve LUTS in men with benign prostatic hyperplasia/ ED. Furthermore, combination PDE5I and α-1-adrenergic blocker could be a more effective treatment than α-1- adrenergic blocker monotherapy, and the differences between long and short-acting agents were minimal.
참고문헌 (28)
- Jacobsen SJ, "Natural history of prostatism: risk factors for acute urinary retention", J Urol, 158, pp.481~487 (1997)
- Norman RW, "Prostate-related symptoms’ in Canadian men 50 years of age or older: prevalence and relationships among symptoms", Br J Urol, 74, pp.542~550 (1994)
- Andersson KE, "Tadalafil for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: pathophysiology and mechanism(s) of action", Neurourol Urodyn, 30, pp.292~301 (2011)
- Hellstrom WJ, "Effects of acute treatment with tamsulosin vs. alfuzosin on ejaculatory function in normal volunteers", J Urol, 176(4 Pt 1)), pp.1529~1533 (2006)
- Francis SH, "Molecular properties of mammalian proteins that interact with cGMP: protein kinases, cation channels, phosphodiesterases, and multi-drug anion transporters", Front Biosci, 10, pp.2097~2117 (2005)
- AUA guideline on management of benign prostatic hyperplasia, "Chapter 1: Diagnosis and treatment recommendations. AUA Practice Guidelines Committee", J Urol, 170(2 Pt 1), pp.530~547 (2003)
- "Cochrane handbook for systematic reviews of interventions. version 5.1.0" (2011)[URL]
- Jadad AR, "Assessing the quality of reports of randomized clinical trials: is blinding necessary", Control Clin Trials, 17, pp.1~12 (1996)
- Schulz KF, "CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials", BMC Med, 8, pp.18~ (2010)
- Uckert S, "Immunohistochemical distribution of cAMP- and cGMP-phosphodiesterase (PDE) isoenzymes in the human prostate", Eur Urol, 49, pp.740~745 (2006)
- Liu L, "Phosphodiesterase-5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis", Urology, 77, pp.123~129 (2011)
- Laydner HK, "Phosphodiesterase 5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review", BJU Int, 107, pp.1104~1109 (2011)
- Martínez-Salamanca JI, "Phosphodiesterase type 5 inhibitors in the management of non-neurogenic male lower urinary tract symptoms: critical analysis of current evidence", Eur Urol, 60, pp.527~535 (2011)
- Sommer F, "Improved spontaneous erectile function in men with mild-to-moderate arteriogenic erectile dysfunction treated with a nightly dose of sildenafil for one year: a randomized trial", Asian J Androl, 9, pp.134~141 (2007)
- Forgue ST, "Tadalafil pharmacokinetics in healthy subjects", Br J Clin Pharmacol, 61, pp.280~288 (2006)
- Fibbi B, "Characterization of phosphodiesterase type 5 expression and functional activity in the human male lower urinary tract", J Sex Med, 7(1 Pt 1), pp.59~69 (2010)
- Gacci M, "The use of a single daily dose of tadalafil to treat signs and symptoms of benign prostatic hyperplasia and erectile dysfunction", Res Rep Urol, 5, pp.99~111 (2013)
- Konstantinopoulos A, "The impact of daily sildenafil on levels of soluble molecular markers of endothelial function in plasma in patients with erectile dysfunction", Expert Opin Pharmacother, 10, pp.155~160 (2009)
- Kaplan SA, "Combination of alfuzosin and sildenafil is superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction", Eur Urol, 51, pp.1717~1723 (2007)
- Bechara A, "Comparative efficacy assessment of tamsulosin vs. tamsulosin plus tadalafil in the treatment of LUTS", BPH, 2008, pp.5, 2170~2178
- Liguori G, "Efficacy and safety of combined oral therapy with tadalafil and alfuzosin: an integrated approach to the management of patients with lower urinary tract symptoms and erectile dysfunction", Preliminary report. J Sex Med, 6, pp.544~552 (2009)
- Tuncel A, "Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction", World J Urol, 28, pp.17~22 (2010)
- Gacci M, "A randomized, placebo-controlled study to assess safety and efficacy of vardenafil 10 mg and tamsulosin 0.4 mg vs. tamsulosin 0.4 mg alone in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia", J Sex Med, 9, pp.1624~1633 (2012)
- Ozturk MI, "Karaman MI. Acute effects of sildenafil on uroflowmetric parameters in erectile dysfunction patients with and without lower urinary tract symptoms", J Androl, 33, pp.1165~1168 (2012)
- Regadas RP, "Urodynamic effects of the combination of tamsulosin and daily tadalafil in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia: a randomized, placebo-controlled clinical trial", Int Urol Nephrol, 45, pp.39~43 (2013)
- Abolyosr A, "Evaluation of the effect of sildenafil and", or doxazosin on Benign prostatic hyperplasia-related lower urinary tract symptoms and erectile dysfunction, 2013, pp.5, 237~240
- Kumar S, "Randomized controlled trial to assess the efficacy of the combination therapy of Alfuzosin and Tadalafil in patients withlower urinary tract symptoms due to benign prostatic hyperplasia", LUTS, 6, pp.35~40 (2014)
- Singh DV, "A comparative randomized prospective study to evaluate efficacy and safety of combination of tamsulosin and tadalafil vs. tamsulosin or tadalafil alone in patients with lower urinary tract symptoms due to benign prostatic hyperplasia", J Sex Med, 11, pp.187~196 (2014)