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Systematic Review of Combination Drug Therapy for Non-neurogenic Lower Urinary Tract Symptoms

Serati, Maurizio; Andersson, Karl-Erik LU ; Dmochowski, Roger; Agrò, Enrico Finazzi; Heesakkers, John; Iacovelli, Valerio; Novara, Giacomo; Khullar, Vik and Chapple, Christopher (2019) In European Urology 75(1). p.129-168
Abstract

Context: 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. Objective: This systematic review analyzes the efficacy and adverse events of combination therapies for male and female LUTS. Evidence acquisition: 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,... (More)

Context: 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. Objective: This systematic review analyzes the efficacy and adverse events of combination therapies for male and female LUTS. Evidence acquisition: 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. Evidence synthesis: 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. Conclusions: 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. Patient summary: Some combination of drugs may offer advantages over monotherapies for the treatment of voiding and storage complaints in men and women. For the treatment of lower urinary tract symptoms (LUTS) in men and women, combination therapy appears to be a promising option to optimize the efficacy of the available drugs. This add-on scenario offers the possibility to have a more tailored approach to the management of LUTS.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adrenergic β3 receptor agonists, Antimuscarinics, Benign prostatic hyperplasia, Overactive bladder, α1-Adrenoceptor antagonist
in
European Urology
volume
75
issue
1
pages
129 - 168
publisher
Elsevier
external identifiers
  • scopus:85054161017
ISSN
0302-2838
DOI
10.1016/j.eururo.2018.09.029
language
English
LU publication?
yes
id
337a7f8f-e55c-43b3-be6f-a6ed79db94c2
date added to LUP
2018-10-22 14:57:26
date last changed
2019-02-20 11:32:50
@article{337a7f8f-e55c-43b3-be6f-a6ed79db94c2,
  abstract     = {<p>Context: 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. Objective: This systematic review analyzes the efficacy and adverse events of combination therapies for male and female LUTS. Evidence acquisition: 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. Evidence synthesis: 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. Conclusions: 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. Patient summary: Some combination of drugs may offer advantages over monotherapies for the treatment of voiding and storage complaints in men and women. For the treatment of lower urinary tract symptoms (LUTS) in men and women, combination therapy appears to be a promising option to optimize the efficacy of the available drugs. This add-on scenario offers the possibility to have a more tailored approach to the management of LUTS.</p>},
  author       = {Serati, Maurizio and Andersson, Karl-Erik and Dmochowski, Roger and Agrò, Enrico Finazzi and Heesakkers, John and Iacovelli, Valerio and Novara, Giacomo and Khullar, Vik and Chapple, Christopher},
  issn         = {0302-2838},
  keyword      = {Adrenergic β3 receptor agonists,Antimuscarinics,Benign prostatic hyperplasia,Overactive bladder,α1-Adrenoceptor antagonist},
  language     = {eng},
  number       = {1},
  pages        = {129--168},
  publisher    = {Elsevier},
  series       = {European Urology},
  title        = {Systematic Review of Combination Drug Therapy for Non-neurogenic Lower Urinary Tract Symptoms},
  url          = {http://dx.doi.org/10.1016/j.eururo.2018.09.029},
  volume       = {75},
  year         = {2019},
}