Combination therapy best for BPH
Long-term combination therapy with the alpha-adrenoceptor blocking drug doxazosin and the 5a-reductase inhibitor finasteride (Proscar) reduces the progression of benign prostatic hyperplasia (BPH) more than treatment with either drug alone.
In a double-blind trial 3,047 men aged 50 years or over with symptoms
of BPH were randomly assigned to receive placebo, finasteride 5mg daily,
doxazosin 1mg daily or combination therapy. The doxazosin dose was doubled
weekly up to 8mg daily.
Over a mean follow up of 4.5 years, the risk of overall clinical progression
of BPH compared with placebo was reduced by 39 per cent with doxazosin
treatment (P<0.001), 34 per cent with finasteride treatment (P=0.002),
and 66 per cent with the two drugs combined (P<0.001). Progression
was defined as worsening of symptoms, acute urinary retention, incontinence,
urinary tract infection, or renal insufficiency. Compared with placebo,
the risks of acute urinary retention and the need for invasive therapy
were reduced by combination therapy and finasteride monotherapy, but
not by doxazosin monotherapy.
The researchers conclude that long-term combination treatment is appropriate
in men with increased risk of disease progression (New England Journal
of Medicine 2003;349:2387). |
