Fan Zhinan, Shi Hongjin, Zhang Jinsong, Wang Haifeng, Wang Jiansong
Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
Front Pharmacol. 2022 Mar 7;13:763184. doi: 10.3389/fphar.2022.763184. eCollection 2022.
Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) are common in middle-aged and elderly men. The current drugs for treating this disease include α1-adrenoceptor antagonists (ABs), muscarinic receptor antagonists (MRAs), phosphodiesterase five inhibitors (PDE5-Is), and β3-adrenoceptor agonists (B3As). However, direct comparative studies analyzing different therapies are limited; therefore, we conducted a network meta-analysis (NMA) to evaluate the efficacy of different drug regimens for treating BPH/LUTS. The PubMed, EMbase, Web of Science, and Cochrane Library databases were searched to collect randomized controlled trials (RCTs) of different drug treatments for BPH/LUTS from January 2000 to April 2021. The NMA was performed using R 4.1 software. Fifty-five RCTs were included among a total of 1639 trials. ① ABs + PDE5-Is, ABs + B3As, ABs + MRAs, ABs, and PDE5-IS were superior to the placebo in improving the total International Prostate Symptom Score (IPSS), IPSS-Voiding, and IPSS-storage. ② For increasing the maximum flow rate (Qmax), ABs + PDE5-Is, ABs + MRAs, and ABs were more effective than the placebo. ③ Regarding reducing post-void residual urine (PVR), none of the six treatment plans had significant effects. Combination therapy showed greater efficacy than monotherapy, and ABs + PDE5-Is was the most successful treatment for improving the overall IPSS score. ABs are a primary therapeutic measure to increase Qmax, and ABs + PDE5-I may be a more suitable choice for enhancing Qmax. The combination of MRA and AB+ MRA may lead to an increase in PVR. : [website], identifier [registration number].
良性前列腺增生（BPH）引起的下尿路症状（LUTS）在中老年男性中很常见。目前治疗该疾病的药物包括α1-肾上腺素能受体拮抗剂（ABs）、毒蕈碱受体拮抗剂（MRAs）、磷酸二酯酶5抑制剂（PDE5-Is）和β3-肾上腺素能受体激动剂（B3As）。然而，分析不同疗法的直接对比研究有限；因此，我们进行了一项网状Meta分析（NMA）以评估不同药物方案治疗BPH/LUTS的疗效。检索了PubMed、EMbase、科学网和考克兰图书馆数据库，以收集2000年1月至2021年4月期间不同药物治疗BPH/LUTS的随机对照试验（RCTs）。使用R 4.1软件进行NMA。在总共1639项试验中纳入了55项RCTs。①ABs + PDE5-Is、ABs + B3As、ABs + MRAs、ABs和PDE5-IS在改善国际前列腺症状总评分（IPSS）、IPSS排尿评分和IPSS储尿评分方面优于安慰剂。②对于增加最大尿流率（Qmax），ABs + PDE5-Is、ABs + MRAs和ABs比安慰剂更有效。③关于减少残余尿量（PVR），六种治疗方案均无显著效果。联合治疗显示出比单一治疗更大的疗效，ABs + PDE5-Is是改善整体IPSS评分最成功的治疗方法。ABs是增加Qmax的主要治疗措施，ABs + PDE5-I可能是提高Qmax更合适的选择。MRA与AB + MRA联合使用可能会导致PVR增加。：[网站]，标识符[注册号]
