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 .
Combination therapy with solifenacin and tamsulosin oral controlled absorption system in a single tablet for lower urinary tract symptoms in men: efficacy and safety results from the randomised controlled NEPTUNE trial.
BACKGROUND Storage symptoms are particularly bothersome in men with lower urinary tract symptoms ( LUTS ) but may not be adequately treated by α-blocker monotherapy . OBJECTIVE To assess the efficacy and safety of a fixed-dose combination ( FDC ) of solifenacin and an oral controlled absorption system ( OCAS ) formulation of tamsulosin compared with placebo and compared with tamsulosin OCAS ( TOCAS ) monotherapy in men with moderate to severe storage symptoms and voiding symptoms . DESIGN , SETTING , AND PARTICIPANTS A double-blind 12-wk phase 3 study in 1334 men with storage and voiding LUTS : total International Prostate Symptom Score ( IPSS ) ≥ 13 , maximum urinary flow rate ( Qmax ) 4.0 - 12.0 ml/s , two or more urgency episodes per 24 h of Patient Perception of Intensity of Urgency Scale grade 3 or 4 , and eight or more micturitions per 24h . INTERVENTION Patients were r and omised to placebo , TOCAS 0.4 mg , FDC solifenacin 6 mg plus TOCAS 0.4 mg , or FDC solifenacin 9 mg plus TOCAS 0.4 mg . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary efficacy end points were ( 1 ) total IPSS and ( 2 ) Total Urgency and Frequency Score ( TUFS ) . An FDC met the success criteria if it demonstrated superiority compared with placebo and noninferiority compared with TOCAS for total IPSS , as well as superiority compared with TOCAS for TUFS . RESULTS AND LIMITATIONS Reductions in total IPSS and TUFS were observed with both solifenacin 6 mg plus TOCAS ( -7.0 and -8.1 , respectively ) and solifenacin 9 mg plus TOCAS ( -6.5 and -7.6 , respectively ) compared with TOCAS ( -6.2 and -6.7 , respectively ) and placebo ( -5.4 and -4.4 , respectively ) . Solifenacin 6 mg plus TOCAS met all prespecified success criteria for both primary end points , while solifenacin 9 mg plus TOCAS met success criteria compared with placebo but not compared with TOCAS . Both FDCs improved quality of life ( QoL ) measures and were well tolerated , with low incidences of acute urinary retention . CONCLUSIONS The FDC of solifenacin 6 mg plus TOCAS significantly improved storage and voiding symptoms , as well as QoL parameters , compared with placebo . This FDC also improved storage symptoms and QoL compared with TOCAS alone in men with moderate to severe storage symptoms and voiding symptoms  , and it was well tolerated
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 .