Dataset Information

Alpha-1 Adrenergic Receptor Blockers for the Treatment of Lower Urinary Tract Symptoms in Women: A Systematic Review and Meta-Analysis.

ABSTRACT:

Purpose

To assess the effectiveness of alpha-1 adrenergic receptor blockers (?1-blockers) in the treatment of female lower urinary tract symptoms (LUTS).

Methods

A literature search was conducted using the PubMed/MEDLINE, Embase, and Cochrane Library databases. Fourteen studies with 1,319 patients were ultimately included. The study comprised 2 analyses: a comparison of urinary symptom scores, maximal flow rate (Qmax), and postvoid residual (PVR) urine volume before and after ?1-blocker administration in 8 prospective, open-label studies and 5 randomized clinical trials (RCTs); and an evaluation of the same variables in ?1-blocker and placebo groups in 4 RCTs.

Results

The first meta-analysis showed that, following treatment, patients exhibited statistically significant symptom relief (mean difference [MD], -5.85; 95% confidence interval [CI], -7.71 to -3.99; P<0.00001), increased Qmax (MD, 3.67 mL/sec; 95% CI, 2.76-4.59 mL/sec; P<0.00001), and decreased PVR volume (MD, -28.46 mL; 95% CI, -34.99 to -21.93 mL; P<0.00001). In the second meta-analysis, ?1-blockers demonstrated significant symptom relief relative to placebo (MD, -1.60; 95% CI, -2.68 to -0.51; P=0.004). However, no significant differences were observed in Qmax (MD, 0.05 mL/sec; 95% CI, -0.74 to 0.83 mL/sec, P=0.91) and PVR (MD, -8.10 mL; 95% CI, -32.32 to 16.12 mL, P=0.51) between the ?1-blocker and placebo groups.

Conclusion

These analyses suggest that ?1-blockers are effective in the treatment of female LUTS patients. However, the effect of ?1-blockers on female LUTS should be assessed according to the underlying cause, and the role of ?1-blockers in combination therapy with other drugs should also be investigated.

SUBMITTER: Kim DK

PROVIDER: S-EPMC6449654 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Alpha-1 Adrenergic Receptor Blockers for the Treatment of Lower Urinary Tract Symptoms in Women: A Systematic Review and Meta-Analysis.

Kim Do Kyung DK Lee Joo Yong JY Jung Jae Hung JH Kim Jae Heon JH Hah Yoon Soo YS Hong Chang Hee CH Cho Kang Su KS

International neurourology journal 20190331 1

<h4>Purpose</h4>To assess the effectiveness of alpha-1 adrenergic receptor blockers (α1-blockers) in the treatment of female lower urinary tract symptoms (LUTS).<h4>Methods</h4>A literature search was conducted using the PubMed/MEDLINE, Embase, and Cochrane Library databases. Fourteen studies with 1,319 patients were ultimately included. The study comprised 2 analyses: a comparison of urinary symptom scores, maximal flow rate (Qmax), and postvoid residual (PVR) urine volume before and after α1-b ...[more]

PMID: 30943695

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Project description:Aims: The aim of this study was to evaluate the effects of alpha blockers in women with lower urinary tract symptoms. Methods: We conducted systematic review and meta-analysis on published a priori protocols. We searched multiple data sources for published and unpublished randomized controlled trials in any language. Primary outcomes included urologic symptom scores, quality of life, and overall adverse events. We performed meta-analysis using RevMan 5.3 and rated the certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation. Results: Alpha blockers likely reduced urological symptom score (mean difference: −1.50, 95% confidence interval: −2.91 to −0.09; moderate certainty of evidence). Alpha blockers may improve quality of life (standardized mean difference: −0.35, 95% confidence interval: −0.85 to 0.15; low certainty of evidence) and have little to no difference in overall adverse events (risk ratio: 1.09, 95% confidence interval: 0.55 to 2.15; low certainty of evidence). Based on five studies comparing combination therapy with alpha blockers and anticholinergics to anticholinergic monotherapy, combination therapy likely results in little to no difference in urological symptom score (mean difference: −0.35, 95% confidence interval: −1.98 to 1.27; moderate certainty of evidence) and quality of life (mean difference: −0.11, 95% confidence interval: −0.48 to 0.27; moderate certainty of evidence). We are very uncertain about the effect of combination therapy on overall adverse events (risk ratio: 1.07, 95% confidence interval: 0.40 to 2.84; very low certainty of evidence). Conclusion: Alpha blocker monotherapy for the women with lower urinary tract symptoms regardless of the underlying cause likely has satisfactory efficacy compared with placebo. However, combination therapy with anticholinergics likely has no additional effect on urologic symptom score and quality of life compared with anticholinergic monotherapy.

Project description:OBJECTIVES:We aimed to synthesise the available data for the effect of stopping alpha-blocker therapy among men with lower urinary tract symptoms. The focus was on symptom, uroflowmetry and quality of life outcomes, but we also reviewed the adverse events (AEs) and the number of patients who restarted therapy. DATA SOURCES:We searched MEDLINE/PubMed, EMBASE/Ovid and The Cochrane Central Register of Controlled Trials from inception to May 2018. ELIGIBILITY CRITERIA:We selected studies regardless of study design in which men were treated with an alpha-blocker for at least 3 months and in which the effects of alpha-blocker discontinuation were subsequently studied. Only controlled trials were used for the primary objective. DATA EXTRACTION AND SYNTHESIS:Two reviewers independently extracted data and assessed the risk of bias for the controlled studies only using the Cochrane Collaboration's tool for assessing risk of bias. Data were pooled using random-effects meta-analyses. RESULTS:We identified 10 studies (1081 participants) assessing the primary objective. Six studies (733 participants) assessed differences in AEs between continuation and discontinuation, and six studies (501 participants) reported the numbers of subjects that restarted treatment after discontinuation. No studies in primary care were identified. After discontinuing monotherapy, symptom scores increased and peak flow rates decreased at 3 and 6 months, but not at 12 months; however, neither parameter changed when alpha-blockers were stopped during combination therapy. Small differences in post-void residual volumes and quality of life scores were considered clinically irrelevant. We also found that 0%-49% of patients restarted after stopping alpha-blocker therapy and that AEs did not increase with discontinuation. CONCLUSIONS:Discontinuing alpha-blocker monotherapy leads to a worsening compared with continuing therapy. Discontinuing the alpha-blocker after combination therapy had no significant effects on outcomes in either the short or long term. Discontinuation may be appropriate for the frail, elderly or those with concomitant illness or polypharmacy. However, studies in primary care are lacking. PROSPERO REGISTRATION NUMBER:CRD42016032648.

Dataset Information

Alpha-1 Adrenergic Receptor Blockers for the Treatment of Lower Urinary Tract Symptoms in Women: A Systematic Review and Meta-Analysis.

Purpose

Methods

Results

Conclusion

Publications

Alpha-1 Adrenergic Receptor Blockers for the Treatment of Lower Urinary Tract Symptoms in Women: A Systematic Review and Meta-Analysis.

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