Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA; Institute of Laboratory Medicine, Lund University, Lund, Sweden.
Eur Urol. 2019 Jan;75(1):129-168. doi: 10.1016/j.eururo.2018.09.029. Epub 2018 Oct 4.
Several drugs are approved and available for the treatment of lower urinary tract symptoms (LUTS) in men and women. However, the vast majority of available data, upon which the approval and recommendation in guidelines are based, considered only the role of the monotherapies and did not evaluate possible combination therapies.
This systematic review analyzes the efficacy and adverse events of combination therapies for male and female LUTS.
A systematic literature search in the PubMed/Medline, Web of Science, and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement to identify clinical trials, randomized controlled trials, meta-analyses, and guidelines on male and female LUTS combination therapy published from March 2012 to December 2017 for men (in order to update a previous men-focused work) and from January 1988 to December 2017 for women. A total of 58 papers were identified.
The most studied combination therapy for the treatment of male LUTS is the α1-adrenoceptor antagonist/5α-reductase inhibitor combination. This combination seems to be more efficacious in terms of several outcome variables, in particular in men who have moderate-to-severe LUTS and are at risk of disease progression. Also in terms of nocturia improvements, this combination is significantly more effective than the monotherapy. The other often studied combination treatment, in both male and female patients with LUTS, was the combination of antimuscarinics (in particular solifenacin) and mirabegron. This combination seems to be more effective in comparison with the monotherapies with respect to urinary incontinence and urgency urinary incontinence episodes and several other objective and subjective parameters, without relevant increase of adverse events. The combination of hormone therapy and antimuscarinics in women with LUTS does not seem to be useful.
For the treatment of LUTS in men and women, combination therapy appears to be a promising option to optimize the efficacy of the available drugs for those who do not experience sufficient benefit with monotherapy. This add-on scenario offers the possibility to have a more tailored approach to the management of LUTS, always seeking the optimal balance between efficacy and tolerability for a given patient.
Some combination of drugs may offer advantages over monotherapies for the treatment of voiding and storage complaints in men and women.
有几种药物已被批准用于治疗男性和女性的下尿路症状（LUTS），并可在临床上应用。然而，绝大多数现有数据，以及基于这些数据而在指南中推荐的药物，仅考虑了单一疗法的作用，而没有评估可能的联合治疗方案。
本系统评价分析了男性和女性 LUTS 联合治疗的疗效和不良事件。
根据系统评价和荟萃分析的首选报告项目声明，在 PubMed/Medline、Web of Science 和 Cochrane 数据库中进行了系统的文献检索，以确定 2012 年 3 月至 2017 年 12 月期间发表的男性 LUTS 联合治疗的临床试验、随机对照试验、荟萃分析和指南（以更新之前的男性重点工作），以及 1988 年 1 月至 2017 年 12 月期间发表的女性 LUTS 联合治疗的临床试验、随机对照试验、荟萃分析和指南。共确定了 58 篇论文。
治疗男性 LUTS 最常用的联合治疗方法是α1 肾上腺素能受体拮抗剂/5α-还原酶抑制剂联合治疗。这种联合治疗在许多结局变量方面似乎更有效，特别是在有中重度 LUTS 且有疾病进展风险的男性中。在改善夜间多尿方面，这种联合治疗也明显优于单一疗法。另一种在男性和女性 LUTS 患者中经常联合使用的治疗方法是抗胆碱能药物（特别是索利那新）和米拉贝隆的联合治疗。与单一疗法相比，这种联合治疗在尿失禁和急迫性尿失禁发作以及其他一些客观和主观参数方面似乎更有效，且不良事件无明显增加。激素治疗和抗胆碱能药物联合治疗女性 LUTS 似乎没有效果。
对于男性和女性的 LUTS 治疗，联合治疗似乎是一种有前途的选择，可以优化现有药物的疗效，对于那些单一治疗获益不足的患者。这种附加方案提供了一种更具针对性的管理 LUTS 的方法，始终在特定患者的疗效和耐受性之间寻求最佳平衡。
一些药物联合治疗可能比单一疗法在治疗男性和女性排尿和储存症状方面更有优势。
