Re: Alpha-Blockers with or without Phosphodiesterase Type 5 Inhibitor for Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis
Abstract
available at http://www.ncbi.nlm.nih.gov/pubmed/29948047 Editorial Comment: There is an impetus within the pharmaceutical world to develop various types of combinations of medications. In part, this is to bypass expiration of patents with monotherapies as well as use of generic substitutes of compounds whose original branded version was developed by other companies. In addition, sustainability of a dual drug may be higher because it is easier to take 1 pill vs 2. From an efficacy perspective there is a theoretical advantage of this as one would expect an additive effect and perhaps an occasional synergistic hyper response. From a reality perspective this often does not occur. In the urology world, and more specifically when treating lower urinary tract symptoms, various combinations have been reported. The first was an alpha blocker combined with a 5alpha-reductase inhibitor. Of note, an attempt to brand this combination as a single agent did not fare well in the United States for a variety of reasons, including emergence of tamsulosin as a generic. These authors perform a meta-analysis of various reports on a combined alpha blocker and phosphodiesterase type 5 (PDE5) inhibitor. The overall improvements in symptoms and flow rate were not significantly different than monotherapy with an alpha blocker. However, erectile function improved significantly, with the preponderance of this phenomenon being driven by the PDE5 inhibitor. Moreover, given that to date we do not have a…
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