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 .
Cardiovascular safety in refractory incontinent patients with overactive bladder receiving add‐on mirabegron therapy to solifenacin (BESIDE)
Summary Aims / objectives : In the BESIDE study , combination therapy ( antimuscarinic [ solifenacin ] and β3‐adrenoceptor agonist [ mirabegron ] ) improved efficacy over solifenacin monotherapy without exacerbating anticholinergic side effects in overactive bladder ( OAB ) patients ; however , a potential synergistic effect on the cardiovascular ( CV ) system requires investigation . Methods OAB patients remaining incontinent despite daily solifenacin 5 mg during 4‐week single‐blind run‐in , were r and omised 1:1:1 to double‐blind daily combination ( solifenacin 5 mg/mirabegron 25 mg , increasing to 50 mg after week 4 ) , solifenacin 5 or 10 mg for 12 weeks . CV safety assessment s included frequency of CV‐related treatment‐emergent adverse events ( TEAEs ) , change from baseline in vital signs ( systolic blood pressure [ SBP ] , diastolic blood pressure [ DBP ] , pulse rate ) and electrocardiogram ( ECG ) parameters . Results The frequency of hypertension , tachycardia and ECG QT prolongation , respectively , was low and comparable across combination ( 1.1 % , 0.3 % , 0.1 % ) , solifenacin 5 mg ( 0.7 % , 0.1 % , 0.1 % ) , and solifenacin 10 mg groups ( 0.8 % , 0 % , 0.1 % ) . Adjusted mean ( SE ) change from baseline to end of treatment ( EoT ) in SBP , DBP , and pulse rate with combination ( 0.07 mm Hg [ 0.38 ] , −0.35 mm Hg [ 0.26 ] , 0.47 bpm [ 0.28 ] ) , solifenacin 5 mg ( −0.93 mm Hg [ 0.38 ] , −0.45 mm Hg [ 0.26 ] , 0.43 bpm [ 0.28 ] ) and solifenacin 10 mg ( −1.28 mm Hg [ 0.38 ] , −0.48 mm Hg [ 0.26 ] , 0.27 bpm [ 0.28 ] ) was generally comparable , with the exception of a mean treatment difference of ~1 mm Hg in SBP between combination and solifenacin monotherapy ; SBP was unchanged with combination and decreased with solifenacin monotherapy . Mean changes from baseline to EoT in ECG parameters were generally similar across treatment groups , except for QT interval corrected using Fridericia 's formula , which was higher with solifenacin 10 mg ( 3.30 mseconds ) vs. combination ( 0.49 mseconds ) and solifenacin 5 mg ( 0.77 mseconds ) . Conclusion The comparable frequency of CV‐related TEAEs , changes in vital signs and ECG parameters indicates no synergistic effect on CV safety outcomes when mirabegron and solifenacin are combined
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 .