This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for > 1 yr ; when given for < 1 yr , α1-blockers alone are just as effective .
The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events .
It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after > 6 yr .
The α1-blocker/muscarinic receptor antagonist ( antimuscarinic ) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy .
Inconsistent data derive from heterogeneous study population s and different study design s. Currently , the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy .
The combination seems to be safe in men with postvoid residual < 200 ml .
The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports .
CONCLUSIONS An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for > 1 yr .
Based on short-term follow-up studies , add-on of antimuscarinics to α1-blockers is an option when postvoid residual is < 200 ml
BACKGROUND Several drugs are approved for the treatment of lower urinary tract symptoms ( LUTS ) in men , but these are mostly used by clinicians as monotherapies .
The combination of different compounds , each of which targets a different aspect of LUTS , seems appealing .
However , only few clinical trials have evaluated the effects of combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS .
The influence of baseline parameters on changes in international prostate symptom score with dutasteride, tamsulosin, and combination therapy among men with symptomatic benign prostatic hyperplasia and an enlarged prostate: 2-year data from the CombAT study.
BACKGROUND Knowledge of baseline factors that influence outcomes for men with benign prostatic hyperplasia ( BPH ) receiving medical therapy may help to improve outcomes and cost effectiveness . OBJECTIVES To examine the influence of baseline parameters on changes in International Prostate Symptom Score ( IPSS ) and maximum urinary flow rate ( Q(max ) ) in men with BPH receiving dutasteride , tamsulosin , or a combination of the two using 2-yr Combination of Avodart and Tamsulosin ( CombAT ) study data . DESIGN , SETTING , AND PARTICIPANTS CombAT is an ongoing , 4-yr , multicentre , r and omised , double-blind study in 4844 men aged > or=50 yr with clinical diagnosis of BPH , IPSS > or=12 , prostate volume > or=30 cm(3 ) , prostate-specific antigen ( PSA ) 1.5 - 10 ng/ml , and Q(max ) > 5 and < or=15 ml/s with minimum voided volume > or=125 ml . INTERVENTION Daily tamsulosin 0.4 mg , dutasteride 0.5 mg , or the combination . MEASUREMENTS Post hoc analyses of mean IPSS and Q(max ) changes from baseline by treatment group and by baseline prostate volume , PSA , age , body mass index ( BMI ) , IPSS , IPSS quality of life ( QoL ) score , BPH Impact Index score , Q(max ) , and previous BPH medical therapy . RESULTS AND LIMITATIONS Combination therapy was more effective than either monotherapy after 24 mo in improving IPSS in all baseline subgroups , with benefit onset varying by baseline prostate volume . Combination therapy was also more effective in improving Q(max ) versus tamsulosin in all subgroups and versus dutasteride in 10 of 18 subgroups . At 24 mo , dutasteride monotherapy result ed in significantly greater IPSS improvements versus tamsulosin in men with lower age , worse symptoms , worse QoL , less bother , higher BMI , greater Q(max ) , higher prostate volume , and higher PSA at baseline . Post hoc analyses , the lack of placebo control , and the exclusion of men with unsuccessful medical BPH treatment are study limitations . CONCLUSIONS Combination therapy with tamsulosin and dutasteride affords the greatest and the most rapid symptomatic benefit among men with higher baseline prostate volume and is effective regardless of previous BPH medical therapy . Dutasteride monotherapy is more effective than tamsulosin in men with higher baseline prostate volume or PSA and worse symptoms
This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for > 1 yr ; when given for < 1 yr , α1-blockers alone are just as effective .
The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events .
It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after > 6 yr .
The α1-blocker/muscarinic receptor antagonist ( antimuscarinic ) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy .
Inconsistent data derive from heterogeneous study population s and different study design s. Currently , the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy .
The combination seems to be safe in men with postvoid residual < 200 ml .
The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports .
CONCLUSIONS An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for > 1 yr .
Based on short-term follow-up studies , add-on of antimuscarinics to α1-blockers is an option when postvoid residual is < 200 ml
BACKGROUND Several drugs are approved for the treatment of lower urinary tract symptoms ( LUTS ) in men , but these are mostly used by clinicians as monotherapies .
The combination of different compounds , each of which targets a different aspect of LUTS , seems appealing .
However , only few clinical trials have evaluated the effects of combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS .