Based on improvement of mean International Prostate Symptom Score and quality of life scores , the effectiveness of the newer ABs was not different from the older ABs ( moderate strength of evidence [ SOE ] ) , but had more AEs ( low SOE ) .
Antimuscarinics/AB combination therapy had similar outcomes  as AB monotherapy ( all moderate SOE ) , but often had more AEs .
Phosphodiesterase type-5 inhibitors alone or in combination with ABs had similar or inferior outcomes than ABs alone .
Evidence was insufficient for the beta-3 adrenoceptor agonist .
For all newer agents , the evidence was generally insufficient to assess long-term efficacy , prevention of symptom progression , or AEs .
None of the drugs or drug combinations newly used to treat LUTS attributed to BPH showed outcomes superior to traditional AB treatment .
Given the lack of superior outcomes , the studies ' short time-horizon , and less assurance of their safety , their current value in treating LUTS attributable to BPH appears low .
We found none of the new drugs to be better but there was more concern about side effects
CONTEXT Alpha-blockers ( ABs ) and 5-alpha reductase inhibitors have an established role in treating male lower urinary tract symptoms ( LUTS ) attributed to benign prostatic hyperplasia ( BPH ) .
Recently , newer drugs have shown promise for this indication .
OBJECTIVE To assess the comparative effectiveness and adverse effects ( AEs ) of newer drugs to treat LUTS attributed to BPH through a systematic review and meta- analysis .
PATIENT SUMMARY In this paper , we review ed the evidence of newer drugs to treat men with urinary problems attributable to an enlarged prostate .
Tadalafil for the Treatment of Lower Urinary Tract Symptoms in Japanese Men with Benign Prostatic Hyperplasia: Results from a 12-week Placebo-controlled Dose-finding Study with a 42-week Open-label Extension.
OBJECTIVES To examine the efficacy , safety , and dose response of tadalafil once daily in Japanese men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia ( BPH-LUTS ) . METHODS Men ≥45 years with moderate-to-severe BPH-LUTS were r and omized to once-daily placebo ( N = 140 ) , tadalafil 2.5 mg ( N = 142 ) , or tadalafil 5.0 mg ( N = 140 ) , in a 12-week double-blind phase , followed by a 42-week , tadalafil 5.0 mg open-label extension ( OLE ) phase ( N = 394 ) . The primary outcome was total International Prostate Symptom Score ( IPSS ) change from baseline to last available observation in the double-blind phase . RESULTS The least squares ( LS ) mean difference between placebo and tadalafil  in total IPSS change from baseline was -0.7 ( P = 0.201 ) and -1.1 ( P = 0.062 ) for tadalafil 2.5 and 5 mg , respectively ( ANCOVA ; a dose-dependent improvement in placebo-adjusted total IPSS for tadalafil 5 mg versus 2.5 mg of 57 % ) . Repeated- measures analyses identified a significant total IPSS change  for tadalafil 5 mg ( LS mean difference between placebo and tadalafil 5 mg : -1.2 ; P = 0.035 ) , but not tadalafil 2.5 mg , at week 12 . Significant improvements for tadalafil 5 mg were demonstrated ( ANCOVA ) for IPSS obstructive subscore ( P = 0.033 ) and IPSS quality of life index ( P = 0.022 ) . Numerical improvements in IPSS scores were maintained over the OLE phase . Tadalafil was well tolerated with no unexpected adverse events . CONCLUSION Tadalafil ( 5.0 mg ) had a favorable benefit-to-risk profile , supporting further investigation of tadalafil ( 5.0 mg ) in Japanese men with BPH-LUTS
Based on improvement of mean International Prostate Symptom Score and quality of life scores , the effectiveness of the newer ABs was not different from the older ABs ( moderate strength of evidence [ SOE ] ) , but had more AEs ( low SOE ) .
Antimuscarinics/AB combination therapy had similar outcomes  as AB monotherapy ( all moderate SOE ) , but often had more AEs .
Phosphodiesterase type-5 inhibitors alone or in combination with ABs had similar or inferior outcomes than ABs alone .
Evidence was insufficient for the beta-3 adrenoceptor agonist .
For all newer agents , the evidence was generally insufficient to assess long-term efficacy , prevention of symptom progression , or AEs .
None of the drugs or drug combinations newly used to treat LUTS attributed to BPH showed outcomes superior to traditional AB treatment .
Given the lack of superior outcomes , the studies ' short time-horizon , and less assurance of their safety , their current value in treating LUTS attributable to BPH appears low .
We found none of the new drugs to be better but there was more concern about side effects
CONTEXT Alpha-blockers ( ABs ) and 5-alpha reductase inhibitors have an established role in treating male lower urinary tract symptoms ( LUTS ) attributed to benign prostatic hyperplasia ( BPH ) .
Recently , newer drugs have shown promise for this indication .
OBJECTIVE To assess the comparative effectiveness and adverse effects ( AEs ) of newer drugs to treat LUTS attributed to BPH through a systematic review and meta- analysis .
PATIENT SUMMARY In this paper , we review ed the evidence of newer drugs to treat men with urinary problems attributable to an enlarged prostate .