背景:α1-肾上腺素受体拮抗剂(α1-阻滞剂)是用于治疗与良性前列腺增生(BPH)相关的下尿路症状的一线药物。多沙唑嗪胃肠治疗系统(GITS)和坦索罗辛属于2种最常用的α1-阻断剂。进行了系统评价和荟萃分析,以比较这2种α1受体阻滞剂的疗效和耐受性。
方法:使用PubMed对已发表的英文或中文随机对照试验进行了系统评价,EMBASE,科克伦图书馆,CNKI,万方,Vip数据库经过数据提取和质量评估,进行荟萃分析以比较临床参数(国际前列腺症状评分[IPSS]总[IPSS-T],存储[IPSS-S],作废[IPSS-V],最大尿流量[Qmax],和后处理残留)和首次药物摄入后变化的不良事件(AE)。
结果:筛选后,确定了8项合格的随机对照试验,共1316例患者。与坦索罗辛相比,多沙唑嗪-GITS的疗效明显更高(IPSS-TP<.001,IPSS-SP<.001和IPSS-VP<.001)。两种药物的Qmax变化(P=0.477)或后空隙残留(P=0.739)没有显着差异。多沙唑嗪-GITS组的总体不良事件发生率显著降低(风险比:0.77;95%CI:0.54-1.08;P=0.036)。然而,头晕(P=.387),头痛(P=.745),虚弱(P=.693),体位性低血压(P=.114),和逆行射精(P=0.187)两组之间相似。
结论:这项荟萃分析表明,与坦索罗辛相比,多沙唑嗪-GITS在下尿路症状/良性前列腺增生患者中具有更高的疗效和更低的不良事件。
BACKGROUND: Alpha1-adrenoceptor antagonists (α1-blockers) are first-line drugs for the treatment of lower urinary tract symptoms associated with benign prostate hyperplasia (BPH).
Doxazosin gastrointestinal therapeutic system (GITS) and tamsulosin belong to the 2 most frequently prescribed α1-blockers. This systematic
review and meta-analysis was performed to compare the efficacy and tolerability of these 2 α1-blockers.
METHODS: A systematic
review of published randomized controlled trials in English or Chinese language was performed using the PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and Vip databases. After data extraction and quality assessment, the meta-analysis was performed to compare clinical parameters (International Prostate Symptom Score [IPSS] total [IPSS-T], storage [IPSS-S], voiding [IPSS-V], maximum urine flow [Qmax], and postvoid residual) and adverse events (AEs) that changed after first drug intake.
RESULTS: After the screening, 8 eligible randomized controlled trials with 1316 patients were identified.
Doxazosin-GITS showed a significantly higher efficacy compared with tamsulosin (IPSS-T P < .001, IPSS-S P < .001, and IPSS-V P < .001). There were no significant differences between the 2 drugs for changes in Qmax (P = .477) or postvoid residual (P = .739). The overall AEs were significantly lower in the
doxazosin-GITS group (risk ratio: 0.77; 95% CI: 0.54-1.08; P = .036). However, dizziness (P = .387), headache (P = .745), asthenia (P = .693), postural hypotension (P = .114), and retrograde ejaculation (P = .187) were similar between the 2 groups.
CONCLUSIONS: This meta-analysis indicates that doxazosin-GITS has significantly higher efficacy and lower AEs than tamsulosin in patients with lower urinary tract symptoms/benign prostate hyperplasia.