Efficacy and safety of α-blockers plus 5α-reductase inhibitors for benign prostatic hyperplasia: a systematic review and meta-analysis
Abstract
OBJECTIVE
This meta-analysis was conducted to systematically evaluate the efficacy and safety of combination therapy with alpha-adrenergic blockers (α-ABs) and 5α-reductase inhibitors (5α-RIs) for benign prostatic hyperplasia (BPH), providing evidence-based support for clinical decision-making.
METHODS
A comprehensive computerized search was performed in PubMed, MEDLINE, Web of Science, Cochrane Library, and EMBASE to identify relevant controlled trials published from database inception to September 2025. Two researchers independently screened the literature, extracted data, and assessed study quality using the Risk of Bias 2.0 (ROB 2.0) tool. Outcome data were extracted, and statistical analysis was performed. The weighted mean difference (WMD) or standardized mean difference (SMD) was calculated for continuous variables, while relative risk (RR) with 95% confidence intervals (CI) was computed for dichotomous variables. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated using funnel plots and Egger's test.
RESULTS
A total of 9 randomized controlled trials involving 13052 BPH patients were included. Meta-analysis demonstrated that, compared with α-AB monotherapy, combination therapy showed significant advantages in reducing the International Prostate Symptom Score (I-PSS) (MD = -0.20, 95% CI -0.26, -0.14), decreasing prostate volume (PV) (MD = -13.69, 95% CI -18.06, -9.32), increasing the maximum urinary flow rate (Qmax) (MD = 0.21, 95% CI…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 13,052 participants or records.
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