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 .
Efficacy and safety of dutasteride, tamsulosin and their combination in a subpopulation of the CombAT study: 2-year results in Asian men with moderate-to-severe BPH
Although ethnicity-based differences in prostate size and physiology have been reported , results of benign prostatic hyperplasia ( BPH ) treatment trials in predominantly Caucasian patients are assumed to be applicable to non-Caucasian population s. This post hoc analysis investigated whether an Asian sub population of men with moderate-to-severe BPH in the CombAT study achieves treatment responses in line with those of the overall study population . In this double-blind , r and omized , parallel-group trial , 325 Asian men were assigned to treatment with 0.5 mg dutasteride once daily , 0.4 mg tamsulosin once daily or the combination . Decrease in international prostate symptom score ( IPSS ) at month 24 from baseline ( the primary endpoint ) was significantly greater with combination treatment compared with tamsulosin ( P<0.05 ) , and numerically , but not statistically significantly , greater compared with dutasteride .  Mean IPSS was reduced from baseline by 7.5 ( ±0.84 ) in the combination group , by 6.3 ( ±0.86 ) in the dutasteride group and by 4.5 ( ±0.78 ) in the tamsulosin group , result ing in respective mean IPSS at months 24 of 11.4 ( ±0.60 ) , 12.7 ( ±0.70 ) and 14.3 ( ±0.74 ) . The adverse event profile was similar to that observed in the overall CombAT population , and drug-related adverse events were more common with combination therapy ( 26 % ) than with tamsulosin ( 15 % ) or dutasteride ( 9 % ) . No unexpected adverse events emerged . In conclusion , in Asian men with moderate-to-severe lower urinary tract symptoms and an enlarged prostate  , combination therapy achieved significantly greater improvements from baseline BPH symptoms , flow rate , quality of life , reduced prostate volume and improved treatment satisfaction compared with tamsulosin monotherapy
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 .