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 .
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
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 .
Treating Overactive Bladder in Older Patients with a Combination of Mirabegron and Solifenacin: A Prespecified Analysis from the BESIDE Study.
BACKGROUND The BESIDE study demonstrated that combination therapy ( mirabegron and solifenacin 5 mg ) improved  overactive bladder symptoms  versus solifenacin 5 mg or 10 mg , and was well tolerated . OBJECTIVE To ensure efficacy and safety is maintained in older patients ( > 65 yr ) , who usually experience greater symptom severity and comorbidities , a prespecified sub analysis stratified by age group was conducted . DESIGN , SETTING , AND PARTICIPANTS Patients remaining incontinent ( ≥1 episode during 3-d diary ) following 4-wk single-blind daily solifenacin 5 mg were r and omized 1:1:1 to a daily double-blind combination ( solifenacin 5 mg and mirabegron 25 mg , increased to 50 mg at wk 4 ) , solifenacin 5 mg or 10 mg for 12 wk . Four cohorts stratified by age ( < 65 yr , ≥65 yr and < 75 yr , ≥75 yr ) were investigated . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Efficacy assessment s : change from baseline to end of treatment in average daily incontinence ( primary ) and micturition frequency ( key secondary ) , number of incontinence episodes during the 3-d diary ( key secondary ) , and change from baseline in average daily urgency and urgency incontinence episodes . Safety included treatment-emergent adverse events and vital signs . RESULTS AND LIMITATIONS Full analysis set included 2110 patients : 30.9 % aged ≥65 yr and 8.9 % aged ≥75 yr . At the end of treatment , daily , and 3-d incontinence daily micturitions , urgency , and urgency incontinence , were improved in each treatment group and age group ; the largest reductions were observed with combination in each age cohort . There were no notable differences in vital signs or the incidence of treatment-emergent adverse events between treatment and age groups , with the exception of dry mouth , which was highest with solifenacin 10 mg . CONCLUSIONS Efficacy and safety in the overall population is maintained in older ( ≥65 yr ) and elderly ( ≥75 yr ) patients treated with a combination of solifenacin and mirabegron , or solifenacin monotherapy ; irrespective of age , combination was associated with the greatest improvement in overactive bladder symptoms . PATIENT SUMMARY This study investigated the effectiveness and safety of a combination of two different treatments ( mirabegron 50 mg and solifenacin 5 mg ) or solifenacin ( 5 mg or 10 mg ) alone in patients aged < 65 yr or ≥65 yr , and < 75 yr or ≥75 yr with overactive bladder . Symptoms of overactive bladder , such as the urgent need to visit the toilet , incontinence , and frequent urination , were improved with all treatments regardless of the patient 's age , but combination treatment demonstrated the greatest benefit , and was well tolerated
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 .
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
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 .