Combining Drug Therapies for LUTS can Optimize Treatment

By Reuters Staff

NEW YORK (Reuters Health) - Certain drug combinations are more effective than monotherapy for treating non-neurogenic lower urinary tract symptoms (LUTS) in some patients, according to a new systematic review including both men and women.

"Some combination of drugs may offer advantages over monotherapies for the treatment of voiding and storage complaints in men and women," Dr. Maurizio Serati of the University of Insubria in Varese, Italy, and colleagues conclude in their October 4 report in European Urology.

Nearly all data on pharmacological treatment of LUTS is on monotherapies, the authors note. A 2013 systematic review of combination therapies in men concluded that combining alpha-1 receptor agonists (alpha1-blockers) with 5-alpha-reductase inhibitors (5-ARIs) was particularly effective for men with prostate enlargement who were at high risk of disease progression.

Dr. Serati and colleagues analyzed 58 papers, including 40 published since the 2013 review. They also concluded that combining alpha1-blockers with 5-ARIs was the most effective approach in men with prostate enlargement, with significant improvements in quality of life, International Prostate Symptom Score and nocturia. Patients on the combination who discontinued 5-ARIs were more likely to have progression of benign prostatic hyperplasia (BPH) and to require transurethral resection of the prostate (TURP). Adverse events with combination therapy were similar to those seen with either drug as monotherapy, but occurred more frequently.

Combination therapy with solifenacin, an antimuscarinic, and mirabegron, was the other most extensively studied treatment, in both men and women. The combination was more effective than monotherapy for improving micturation frequency, urge urinary incontinence and urgency. Trial participants were primarily female, and results were not reported by gender. Combining the two drugs did not increase adverse events.

Adding hormone therapy to antimuscarinics did not improve LUTS symptoms in women.

"For the treatment of LUTS in men and women, combination therapy appears to be a promising option to optimize the efficacy of the available drugs for those who do not experience sufficient benefit with monotherapy. This add-on scenario offers the possibility to have a more tailored approach to the management of LUTS, always seeking the optimal balance between efficacy and tolerability for a given patient," the authors conclude.

Dr. Serati was not available for an interview by press time.

SOURCE: https://bit.ly/2ydDw6E

Eur Urol 2018.

(c) Copyright Thomson Reuters 2018. Click For Restrictions - https://agency.reuters.com/en/copyright.html