The efficacy and safety of alpha-1 blockers for benign prostatic hyperplasia: an overview of 15 systematic reviews

Abstract

Objective:

A great number of clinical trials and systematic reviews have evaluated the efficacy and safety of α₁ blockers for benign prostatic hyperplasia (BPH). We carried out an overview of reviews to provide an up-to-date summary of evidence regarding the efficacy and safety between different α₁ blockers for BPH.

Research design and methods:

PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database and VIP were searched for eligible studies. Direct evidence was analyzed narratively. We used a random-effects model within a Bayesian framework to calculate indirect estimates if no direct evidence existed. The GRADE approach was used in summarizing conclusions.

Results:

A total of 15 systematic reviews involving five α₁ blockers met the inclusion criteria. Direct evidence demonstrated that α₁ blockers were superior to placebo in reducing urinary symptom scores and improving peak urinary flow PUF. Doxazosin could significantly reduce urinary symptom scores compared with tamsulosin mean difference (MD −1.60, 95% CI −1.80 to −1.40) and alfuzosin (MD1.7, 95% CI 0.76–1.64). Indirect evidence suggested that the urinary symptom score and PUF at endpoint in men treated with naftopidil were similar to those treated with other α₁ blockers. α₁ Blockers generally lead to more adverse effects compared with placebo, and those caused by terazosin were more frequent than others.

Conclusions:

α₁ Blockers are more effective than placebo for BPH, doxazosin and tamsulosin seem to be more effective than other α₁ blockers. The adverse effects caused by α₁ blockers are generally mild and well-tolerated.

Keywords::

• Alpha-1 blockers
• Benign prostatic hyperplasia
• Overview of reviews
• Systematic reviews

Transparency

Declaration of funding

This study was not funded.

Declaration of financial/other relationships

The authors have no relevant financial relationship to disclose. CMRO peer reviewers on this manuscript have no relevant financial relationships to disclose.

Acknowledgments

The authors thank Linlan Ren (The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China) for her kind assistance in editing the paper.