Wang Xinghuan, Wang Xiao, Li Sheng, Meng Zhe, Liu Tao, Zhang Xinhua
Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P.R.China.
PLoS One. 2014 Sep 12;9(9):e107593. doi: 10.1371/journal.pone.0107593. eCollection 2014.
Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are common in elder men and a number of drugs alone or combined are clinically used for this disorder. But available studies investigating the comparative effects of different drug therapies are limited. This study was aimed to compare the efficacy of different drug therapies for LUTS/BPH with network meta-analysis.
An electronic search of PubMed, Cochrane Library and Embase was performed to identify randomized controlled trials (RCTs) comparing different drug therapies for LUTS/BPH within 24 weeks. Comparative effects were calculated using Aggregate Data Drug Information System. Consistency models of network meta-analysis were created and cumulative probability was used to rank different therapies.
A total 66 RCTs covering seven different therapies with 29384 participants were included. We found that α-blockers (ABs) plus phosphodiesterase 5 inhibitors (PDE5-Is) ranked highest in the test of IPSS total score, storage subscore and voiding subscore. The combination therapy of ABs plus 5α-reductase inhibitors was the best for increasing maximum urinary flow rate (Qmax) with a mean difference (MD) of 1.98 (95% CI, 1.12 to 2.86) as compared to placebo. ABs plus muscarinic receptor antagonists (MRAs) ranked secondly on the reduction of IPSS storage subscore, although monotherapies including MRAs showed no effect on this aspect. Additionally, PDE5-Is alone showed great effectiveness for LUTS/BPH except Qmax.
Based on our novel findings, combination therapy, especially ABs plus PDE5-Is, is recommended for short-term treatment for LUTS/BPH. There was also evidence that PDE5-Is used alone was efficacious except on Qmax. Additionally, it should be cautious when using MRAs. However, further clinical studies are required for longer duration which considers more treatment outcomes such as disease progression, as well as basic research investigating mechanisms involving PDE5-Is and other pharmacologic agents alleviate the symptoms of LUTS/BPH.
良性前列腺增生（BPH）所致下尿路症状（LUTS）在老年男性中很常见，临床上单独或联合使用多种药物治疗该疾病。但现有研究对不同药物治疗效果的比较有限。本研究旨在通过网状Meta分析比较不同药物治疗LUTS/BPH的疗效。
对PubMed、Cochrane图书馆和Embase进行电子检索，以识别比较24周内不同药物治疗LUTS/BPH的随机对照试验（RCT）。使用汇总数据药物信息系统计算比较效果。创建网状Meta分析的一致性模型，并使用累积概率对不同治疗方法进行排序。
共纳入66项RCT，涵盖7种不同治疗方法，涉及29384名参与者。我们发现，α受体阻滞剂（ABs）加磷酸二酯酶5抑制剂（PDE5-Is）在国际前列腺症状评分（IPSS）总分、储尿期子评分和排尿期子评分测试中排名最高。ABs加5α还原酶抑制剂的联合治疗在增加最大尿流率（Qmax）方面效果最佳，与安慰剂相比，平均差异（MD）为1.98（95%CI，1.12至2.86）。ABs加毒蕈碱受体拮抗剂（MRAs）在降低IPSS储尿期子评分方面排名第二，尽管包括MRAs在内的单一疗法在这方面没有效果。此外，单独使用PDE5-Is对LUTS/BPH显示出显著疗效，但对Qmax无效。
基于我们的新发现，推荐联合治疗，尤其是ABs加PDE5-Is，用于LUTS/BPH的短期治疗。也有证据表明，单独使用PDE5-Is除对Qmax无效外，其他方面有效。此外，使用MRAs时应谨慎。然而，需要进行更长期的临床研究，考虑更多的治疗结果，如疾病进展，以及基础研究，以探究PDE5-Is和其他药物缓解LUTS/BPH症状的机制。
