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A meta-analysis of the vascular-related safety profile and efficacy of α-adrenergic blockers for symptoms related to benign prostatic hyperplasia

2008; Wiley; Volume: 62; Issue: 10 Linguagem: Inglês

10.1111/j.1742-1241.2008.01880.x

1742-1241

J. Curtis Nickel, Stephan Sander-Faes, T D Moon,

Cardiovascular Syncope and Autonomic Disorders

Objectives: To evaluate the safety profile and efficacy of α1-adrenergic receptor blockers (A1Bs) currently prescribed for benign prostatic hyperplasia (BPH). Data sources: A systematic literature search of MEDLINE, the Cochrane Database and the Food and Drug Administration Web site through December 2006 identified double-blinded, prospective, placebo-controlled trials, evaluating agents commercially available by prescription for the symptomatic treatment of BPH. Review methods: Data were reviewed by two investigators with the use of a standardised data abstraction form. Studies were evaluated for methodological quality using the Jadad scale. Studies with a score of < 3 were considered of weaker methodology. Results: Of 2389 potential citations, 25 were usable for evaluation of safety data, 26 for efficacy. A1B use was associated with a statistically significant increase in the odds of developing a vascular-related event [odds ratio (OR) 2.54; 95% confidence interval (CI): 2.00–3.24; p < 0.0001]. The odds of developing a vascular-related adverse event were: alfuzosin, OR 1.66, 95% CI: 1.17–2.36; terazosin, OR 3.71, 95% CI: 2.48–5.53; doxazosin, OR 3.32, 95% CI: 2.10–5.23 and tamsulosin, OR 1.42, 95% CI: 0.99–2.05. A1Bs increased Qmax by 1.32 ml/min (95% CI: 1.07–1.57) compared with placebo. Difference from placebo in American Urological Association symptom index/International Prostate Symptom Score was −1.92 points (95% CI: −2.71 to −1.14). Conclusions: Alfuzosin, terazosin and doxazosin showed a statistically significant increased risk of developing vascular-related events compared with placebo. Tamsulosin showed a numerical increase that was not statistically significant. All agents significantly improved Qmax and symptom signs compared with placebo.