Mari Andrea, Antonelli Alessandro, Cindolo Luca, Fusco Ferdinando, Minervini Andrea, De Nunzio Cosimo
Department of Urology, University of Florence, Careggi Hospital, San Luca Nuovo, Florence, Italy.
Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Italy.
Ther Adv Urol. 2021 Apr 12;13:1756287221993283. doi: 10.1177/1756287221993283. eCollection 2021 Jan-Dec.
Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are a bothersome frequent symptom in adult males. This systematic review analyzed the available evidence on the pharmacokinetic and pharmacodynamic features of alfuzosin, and its clinical efficacy both as monotherapy and in combination with other drugs for the treatment of male LUTS/BPH.
A systematic review of the last 10 years was performed using the MEDLINE, EMBASE and Cochrane libraries in March 2020. The protocol for this systematic review was registered on PROSPERO (Central Registration Depository: CRD42020136120) and is available in full on the University of York website.
Alfuzosin is a quinazoline derivative and, although a nonspecific α1-blocker, exhibits a selective concentration in the prostate compared with plasma in patients with BPH. Three registration trials assessed the safety and efficacy of alfuzosin. The 10 mg daily formulation has a three-layered matrix containing the active substance between two inactive coats allowing a drug release over 20 h. Alfuzosin showed high tolerability, few vasodilatory effects and a low rate of ejaculation disorders over older alpha-blocking compounds thanks to the high uroselectivity of alfuzosin and its preferential concentration at urinary level. Six randomized clinical trials (RCTs) assessed efficacy and safety of alfuzosin other alpha-blockers ± placebo: three studies comparing with tamsulosin, one with doxazosin, and two with silodosin or tamsulosin. One RCT investigated the clinical outcomes of alfuzosin with finasteride, two with propiverine and two with phosphodiesterase-5 inhibitors.
Alfuzosin is an effective drug for the treatment of LUTS/BPH, with a lower rate of sexual disorders compared with other alpha-blockers. Alfuzosin is also safe with low adverse events in case of concomitant antihypertensive therapy and in patients with cardiovascular morbidity. Safety and efficacy of alfuzosin has been reported also in case of combination therapy with antimuscarinic agents and PDE5i.
良性前列腺增生（BPH）继发的下尿路症状（LUTS）是成年男性常见的困扰性症状。本系统评价分析了关于阿夫唑嗪的药代动力学和药效学特征，以及其作为单一疗法和与其他药物联合用于治疗男性LUTS/BPH的临床疗效的现有证据。
2020年3月使用MEDLINE、EMBASE和Cochrane数据库对过去10年进行了系统评价。本系统评价的方案已在PROSPERO（中央注册库：CRD42020136120）注册，可在约克大学网站上全文获取。
阿夫唑嗪是一种喹唑啉衍生物，虽然是非特异性α1受体阻滞剂，但在BPH患者中与血浆相比，在前列腺中表现出选择性浓度。三项注册试验评估了阿夫唑嗪的安全性和有效性。每日10mg剂型有三层基质，活性物质夹在两层无活性包衣之间，使药物在20小时内释放。由于阿夫唑嗪的高尿选择性及其在尿液水平的优先浓度，与 older alpha-blocking compounds相比，阿夫唑嗪显示出高耐受性、很少的血管舒张作用和低射精障碍发生率。六项随机临床试验（RCT）评估了阿夫唑嗪与其他α受体阻滞剂±安慰剂的疗效和安全性：三项研究与坦索罗辛比较，一项与多沙唑嗪比较，两项与西洛多辛或坦索罗辛比较。一项RCT研究了阿夫唑嗪与非那雄胺的临床结果，两项研究与丙哌维林，两项研究与磷酸二酯酶-5抑制剂。
阿夫唑嗪是治疗LUTS/BPH的有效药物，与其他α受体阻滞剂相比，性功能障碍发生率较低。在联合抗高血压治疗和心血管疾病患者中，阿夫唑嗪也安全，不良事件发生率低。在与抗毒蕈碱药物和PDE5i联合治疗的情况下，也报道了阿夫唑嗪的安全性和有效性。
