RT Journal Article
SR Electronic
T1 Discontinuation of alpha-blocker therapy in men with lower urinary tract symptoms: a systematic review and meta-analysis
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e030405
DO 10.1136/bmjopen-2019-030405
VO 9
IS 11
A1 Henk van der Worp
A1 Petra Jellema
A1 Ilse Hordijk
A1 Yvonne Lisman-van Leeuwen
A1 Lisa Korteschiel
A1 Martijn G Steffens
A1 Marco H Blanker
YR 2019
UL http://bmjopen.bmj.com/content/9/11/e030405.abstract
AB Objectives We aimed to synthesise the available data for the effect of stopping alpha-blocker therapy among men with lower urinary tract symptoms. The focus was on symptom, uroflowmetry and quality of life outcomes, but we also reviewed the adverse events (AEs) and the number of patients who restarted therapy.Data sources We searched MEDLINE/PubMed, EMBASE/Ovid and The Cochrane Central Register of Controlled Trials from inception to May 2018.Eligibility criteria We selected studies regardless of study design in which men were treated with an alpha-blocker for at least 3 months and in which the effects of alpha-blocker discontinuation were subsequently studied. Only controlled trials were used for the primary objective.Data extraction and synthesis Two reviewers independently extracted data and assessed the risk of bias for the controlled studies only using the Cochrane Collaboration’s tool for assessing risk of bias. Data were pooled using random-effects meta-analyses.Results We identified 10 studies (1081 participants) assessing the primary objective. Six studies (733 participants) assessed differences in AEs between continuation and discontinuation, and six studies (501 participants) reported the numbers of subjects that restarted treatment after discontinuation. No studies in primary care were identified. After discontinuing monotherapy, symptom scores increased and peak flow rates decreased at 3 and 6 months, but not at 12 months; however, neither parameter changed when alpha-blockers were stopped during combination therapy. Small differences in post-void residual volumes and quality of life scores were considered clinically irrelevant. We also found that 0%–49% of patients restarted after stopping alpha-blocker therapy and that AEs did not increase with discontinuation.Conclusions Discontinuing alpha-blocker monotherapy leads to a worsening compared with continuing therapy. Discontinuing the alpha-blocker after combination therapy had no significant effects on outcomes in either the short or long term. Discontinuation may be appropriate for the frail, elderly or those with concomitant illness or polypharmacy. However, studies in primary care are lacking.PROSPERO registration number CRD42016032648.