📃 Paper Title: The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia (MTOPS study)
🧍 Author: McConnell
🕒 Year: 2003
📚 Journal: New England Journal of Medicine
🌎 Country: United States of America
ㅤContext to the study:
Are there any studies that prove that both an alpha blocker and 5 alpha reductase inhibitor is better than single therapy?
ㅤ✅ Take-home message of study:
Combination therapy (a-blocker and 5a-reductase inhibitor) is superior to monotherapy or no therapy in limiting the progression of benign prostatic hyperplasia.
ㅤ Multi-centre, double-blind, placebo-controlled randomised trial
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Study participants:
Inclusion:
Men over 50 years
AUA LUTS symptoms score 8-30 (/35) and maximum urinary flow rate between 4ml and 15ml per second and with a voided volume of at least 125mls
Exclusion:
Prior BPH surgery
3047 men were randomly assigned to one of four groups (1. placebo, 2. doxazocin, 3. finasteride, 4. doxazosin and finasteride)
Median follow-up was 4.5 years
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Key study outcomes:
The primary outcome was clinical progression (defined as an increase in AUA symptom score of 4, urinary retention, incontinence, recurrent UTI or renal insufficiency). The risk reduction compared to placebo for doxazocin was 39% (p<0.001), for finasteride was 34% (p=0.002), and for combination therapy 66% (p<0.001). The reduction for combination therapy was significantly greater than for either finasteride or doxazocin alone (p<0.001 for each pairwise comparison). There was no significant difference in the reduction comparing finasteride alone and doxazocin alone (p value not given). The NNT to prevent one instance of overall clinical progression was 8.4 for combination therapy, 13.7 for doxazosin, and 15.0 for inasteride.
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Study Limitations:
The use of an AUA symptom score of 4 as the cut-off for progression was largely arbitrary.
The study participants are limited to the United States population
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