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A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia.

Nickel JC, Sander S, Moon TD - Int. J. Clin. Pract. (2008)

Bottom Line: A1Bs increased Q(max) by 1.32 ml/min (95% CI: 1.07-1.57) compared with placebo.Alfuzosin, terazosin and doxazosin showed a statistically significant increased risk of developing vascular-related events compared with placebo.All agents significantly improved Q(max) and symptom signs compared with placebo.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Queen's University, Kingston, Canada. jcn@queensu.ca

ABSTRACT

Objectives: To evaluate the safety profile and efficacy of alpha1-adrenergic receptor blockers (A1Bs) currently prescribed for benign prostatic hyperplasia (BPH).

Data sources: A systematic literature search of MEDLINE, the Cochrane Database and the Food and Drug Administration Web site through December 2006 identified double-blinded, prospective, placebo-controlled trials, evaluating agents commercially available by prescription for the symptomatic treatment of BPH.

Review methods: Data were reviewed by two investigators with the use of a standardised data abstraction form. Studies were evaluated for methodological quality using the Jadad scale. Studies with a score of < 3 were considered of weaker methodology.

Results: Of 2389 potential citations, 25 were usable for evaluation of safety data, 26 for efficacy. A1B use was associated with a statistically significant increase in the odds of developing a vascular-related event [odds ratio (OR) 2.54; 95% confidence interval (CI): 2.00-3.24; p < 0.0001]. The odds of developing a vascular-related adverse event were: alfuzosin, OR 1.66, 95% CI: 1.17-2.36; terazosin, OR 3.71, 95% CI: 2.48-5.53; doxazosin, OR 3.32, 95% CI: 2.10-5.23 and tamsulosin, OR 1.42, 95% CI: 0.99-2.05. A1Bs increased Q(max) by 1.32 ml/min (95% CI: 1.07-1.57) compared with placebo. Difference from placebo in American Urological Association symptom index/International Prostate Symptom Score was -1.92 points (95% CI: -2.71 to -1.14).

Conclusions: Alfuzosin, terazosin and doxazosin showed a statistically significant increased risk of developing vascular-related events compared with placebo. Tamsulosin showed a numerical increase that was not statistically significant. All agents significantly improved Q(max) and symptom signs compared with placebo.

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Related in: MedlinePlus

Odds of developing a vascular-related adverse event while on specific α1-adrenergic receptor blockers. Sizes of the data markers are indicative of the relative weight of each study. The bar is representative of the 95% confidence interval
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fig04: Odds of developing a vascular-related adverse event while on specific α1-adrenergic receptor blockers. Sizes of the data markers are indicative of the relative weight of each study. The bar is representative of the 95% confidence interval

Mentions: Subgroup analysis was conducted, and the results are depicted in Figure 4 and Table 2. When A1Bs were evaluated individually, differences in vascular-related adverse events were observed. There was a significantly higher odds of developing the primary composite end-point relative to placebo for alfuzosin (p = 0.005), terazosin (p< 0.0001), doxazosin (p< 0.0001) and doxazosin GITS (p< 0.0001). The odds of developing a vascular event was higher with tamsulosin relative to placebo, but the difference was not statistically significant (p =0.053). Statistical heterogeneity was not present for alfuzosin, terazosin and tamsulosin (Q-statistic p >0.1); however, statistical heterogeneity could not be ruled out for doxazosin (Q-statistic p =0.039).


A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia.

Nickel JC, Sander S, Moon TD - Int. J. Clin. Pract. (2008)

Odds of developing a vascular-related adverse event while on specific α1-adrenergic receptor blockers. Sizes of the data markers are indicative of the relative weight of each study. The bar is representative of the 95% confidence interval
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2658011&req=5

fig04: Odds of developing a vascular-related adverse event while on specific α1-adrenergic receptor blockers. Sizes of the data markers are indicative of the relative weight of each study. The bar is representative of the 95% confidence interval
Mentions: Subgroup analysis was conducted, and the results are depicted in Figure 4 and Table 2. When A1Bs were evaluated individually, differences in vascular-related adverse events were observed. There was a significantly higher odds of developing the primary composite end-point relative to placebo for alfuzosin (p = 0.005), terazosin (p< 0.0001), doxazosin (p< 0.0001) and doxazosin GITS (p< 0.0001). The odds of developing a vascular event was higher with tamsulosin relative to placebo, but the difference was not statistically significant (p =0.053). Statistical heterogeneity was not present for alfuzosin, terazosin and tamsulosin (Q-statistic p >0.1); however, statistical heterogeneity could not be ruled out for doxazosin (Q-statistic p =0.039).

Bottom Line: A1Bs increased Q(max) by 1.32 ml/min (95% CI: 1.07-1.57) compared with placebo.Alfuzosin, terazosin and doxazosin showed a statistically significant increased risk of developing vascular-related events compared with placebo.All agents significantly improved Q(max) and symptom signs compared with placebo.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Queen's University, Kingston, Canada. jcn@queensu.ca

ABSTRACT

Objectives: To evaluate the safety profile and efficacy of alpha1-adrenergic receptor blockers (A1Bs) currently prescribed for benign prostatic hyperplasia (BPH).

Data sources: A systematic literature search of MEDLINE, the Cochrane Database and the Food and Drug Administration Web site through December 2006 identified double-blinded, prospective, placebo-controlled trials, evaluating agents commercially available by prescription for the symptomatic treatment of BPH.

Review methods: Data were reviewed by two investigators with the use of a standardised data abstraction form. Studies were evaluated for methodological quality using the Jadad scale. Studies with a score of < 3 were considered of weaker methodology.

Results: Of 2389 potential citations, 25 were usable for evaluation of safety data, 26 for efficacy. A1B use was associated with a statistically significant increase in the odds of developing a vascular-related event [odds ratio (OR) 2.54; 95% confidence interval (CI): 2.00-3.24; p < 0.0001]. The odds of developing a vascular-related adverse event were: alfuzosin, OR 1.66, 95% CI: 1.17-2.36; terazosin, OR 3.71, 95% CI: 2.48-5.53; doxazosin, OR 3.32, 95% CI: 2.10-5.23 and tamsulosin, OR 1.42, 95% CI: 0.99-2.05. A1Bs increased Q(max) by 1.32 ml/min (95% CI: 1.07-1.57) compared with placebo. Difference from placebo in American Urological Association symptom index/International Prostate Symptom Score was -1.92 points (95% CI: -2.71 to -1.14).

Conclusions: Alfuzosin, terazosin and doxazosin showed a statistically significant increased risk of developing vascular-related events compared with placebo. Tamsulosin showed a numerical increase that was not statistically significant. All agents significantly improved Q(max) and symptom signs compared with placebo.

Show MeSH
Related in: MedlinePlus