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 .
Sustained-Release Alfuzosin, Finasteride and the Combination of Both in the Treatment of Benign Prostatic Hyperplasia
Objectives : To assess the additive benefit of combining an α1-blocker and a 5α-reductase inhibitor . Methods : This European , r and omized , double-blind , multicenter trial involved 1.051 patients with lower urinary tract symptoms related to benign prostatic hyperplasia . Patients received sustained release ( SR ) alfuzosin ( n = 358 ) , a selective α1-blocker given at a dose of 5 mg twice daily without dose titration ; finasteride ( n = 344 ) , 5 mg once daily , or both drugs ( n = 349 ) , for 6 months . Primary efficacy criteria were symptomatic improvement ( International Prostate Symptom Score : I-PSS ) and maximum flow rate ( Qmax ) . Safety was assessed by monitoring adverse events . Results : Symptomatic improvement was significantly higher from the 1st month of treatment with SR alfuzosin , alone or in combination ; mean changes in I-PSS versus baseline at end-point were –6.3 and –6.1 , respectively , compared with –5.2 with finasteride alone ( SR alfuzosin vs. finasteride , p = 0.01 ; combination vs. finasteride , p = 0.03 ) . The percentages of patients with a decrease in I-PSS of at least 50 % were 43 , 42 and 33 % for SR alfuzosin , the combination and finasteride , respectively ( SR alfuzosin vs. finasteride , p = 0.008 ; combination vs. finasteride , p = 0.009 ) . In the overall population , increases in Qmax were greater with SR alfuzosin and the combination , compared with finasteride alone after 1 month of therapy , but changes at end-point were similar in the three treatment groups . In those 47 % of patients likely to be obstructed ( baseline Qmax < 10 ml/s ) , however , mean increases in Qmax were significantly higher with SR alfuzosin , alone or in combination , whatever the  visit . Finasteride , alone or in combination , significantly impaired sexual function . The incidence of postural symptoms was low and similar in the three treatment groups . Conclusion : In this 6-month trial , SR alfuzosin was more effective than finasteride , with no additional benefit in combining both drugs
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 .