The Efficacy of Drugs for the Treatment of LUTS/BPH, A Study in 6 European Countries

Hutchison, Annie; Farmer, Richard; Verhamme, Katia; Berges, Richard; Navarrete, Remigio Vela

doi:10.1016/j.eururo.2006.06.012

Cited by 106 publications

(62 citation statements)

References 23 publications

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“…an excess of urine culture in Portugal, a lack of standardized symptom and/or QoL assessment in France and Portugal, or a lack of blood pressure measurement by office-based urologists in Germany. Similar conclusions about local healthcare traditions were drawn from the results of the TRIUMPH study [24]. This also raises the question of whether guidelines are addressed to specialists or to GPs, and whether different levels of management should be recommended.…”

Section: Ipsssupporting

confidence: 60%

“…Strikingly, the prescription of combinations was anecdotal, although the present survey was done after the Medical Therapy of Prostatic Symptoms trial which provided scientific evidence of benefit with combined therapy [13]. This result contrasts with those of the TRIUMPH study [24], but confirms that randomized studies impact mostly on urologists [16]. In the recent DUO study [25], which was conducted in France in a similar patient population, urologists prescribed pharmacological treatment to 84% of patients (α-blockers 29%, 5α-reductase inhibitors 24%, a combination of both 22%, or a phytotherapy 6%).…”

Section: Ipsscontrasting

confidence: 54%

“…The overall total of patients surveyed is also limited, which could make it difficult to extrapolate to the general population. However, the clinical profile of the patients was similar to that described in other studies [23][24][25]. As for any observational study, the design can only generate hypotheses that need to be validated in future trials.…”

Section: Ipssmentioning

confidence: 69%

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Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries

Fourcade¹,

Théret²,

Taïeb³

2008

BJU International

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OBJECTIVETo describe the profile and management of patients medically treated for benign prostatic hyperplasia (BPH) in primary care in four European countries, as the diagnosis and management of BPH have developed dramatically in the last decade, and recent information from actual practice is insufficient.PATIENTS AND METHODSThis observational, cross‐sectional study was carried out by general practitioners in France (141 patients), Spain (127) and Portugal (50), and by office‐based urologists in Germany (162 patients) between July 2005 and June 2006. The physicians were unaware of the study sponsor. Patients aged ≥50 years were recruited if a decision for medical treatment of BPH was taken for the first time on that day. The patient and the investigator had to complete one questionnaire each.RESULTSThe physicians included 480 patients, with a mean (sd) age of 65.0 (7.8) years. The mean (sd) International Prostate Symptom Score (IPSS) was 16.0 (7.3). There were geographical differences in age (P = 0.009; patients in Germany being the youngest), IPSS (P = 0.017; patients in Spain having the highest score), quality of life (QoL; IPSS item 8, P < 0.001, the least altered being in Germany), and sexual activity (P = 0.010; the highest proportion of sexually active patients being in Portugal), but not for comorbidities and concomitant medication. The IPSS correlated poorly with age (r = 0.21) and moderately with QoL (r = 0.47). Severe symptoms (IPSS > 19) were not linked with sexual activity (age‐adjusted P = 0.378). Serum prostate specific antigen testing, although not recommended for BPH, was widely used (83.8% overall). All other examinations were carried out disparately depending on the country (P < 0.001 each). Digital rectal examination (DRE) and excluding urinary tract infection (urine culture) were used in ≈75% of study patients, but only half the patients in France had a urine culture, and 52% in Portugal had a DRE. A standardized assessment of symptoms and/or QoL was reported in 45% of study patients, with wide discrepancies among countries, i.e. 77.2% in Germany and 6.0% in Portugal. α‐blocker monotherapy was the most frequently prescribed treatment (62.5% overall, 87.1% in Germany, 46.1% in France), followed by phytotherapy (23.5%), and 5α‐reductase inhibitor monotherapy (3.75%); combinations were rare. Treatment varied according to the severity of the symptoms (P = 0.008), phytotherapy being given to patients with the lowest IPSS, and combinations to those with the highest IPSS.CONCLUSIONThere were geographical discrepancies that could be attributed to either different cultural habits or merely organisational differences, e.g. the presence of office urologists in Germany or diverse modes of access to phytotherapy (prescription vs ‘over the counter’) in the various countries.

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Section: Ipsssupporting

confidence: 60%

Section: Ipsscontrasting

confidence: 54%

Section: Ipssmentioning

confidence: 69%

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Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries

Fourcade¹,

Théret²,

Taïeb³

2008

BJU International

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“…15,16 However, they were observational in nature and therefore are of limited value for evaluation of efficacy. Such studies have shown marked national differences in prescribing patterns, both in individual drug choice and in the use of combination therapies.…”

Section: Discussionmentioning

confidence: 99%

The effects of combination therapy with dutasteride plus tamsulosin on clinical outcomes in men with symptomatic BPH: 4-year post hoc analysis of European men in the CombAT study

Haillot

Fraga

Maciukiewicz³

et al. 2011

Prostate Cancer Prostatic Dis

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CombAT (Combination of Avodart and Tamsulosin) was a randomised, double-blind study in men (n ¼ 4844) aged X50 years with a clinical diagnosis of BPH. Patients were randomised to daily tamsulosin 0.4 mg, dutasteride 0.5 mg or both for 4 years. The primary endpoint was time to acute urinary retention (AUR) or BPH-related surgery. Secondary endpoints included BPH clinical progression, symptoms and maximum urinary flow rate. A post hoc analysis of data from the European subgroup was conducted. A total of 2925 men were randomised to treatment in Europe as part of CombAT (tamsulosin, n ¼ 972; dutasteride, n ¼ 970; combination, n ¼ 983). Combination therapy significantly reduced the relative risk of AUR or BPH-related surgery compared with either monotherapy at 4 years, and also significantly reduced the risk of BPH clinical progression. Combination therapy also provided significantly greater symptom improvement than either monotherapy at 4 years. Safety and tolerability of dutasteride plus tamsulosin was consistent with previous experience of this combination and with the monotherapies. These data provide further evidence to support the use of long-term combination therapy (dutasteride plus tamsulosin) in men with moderate-to-severe lower urinary tract symptoms because of BPH and prostatic enlargement. The results in the European subgroup are generally consistent with those in the overall study population.

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“…[19][20][21][22][23][24][25][26][27] (Level 1 Evidence, Grade A Recommendation). Alfuzosin, doxazosin, tamsulosin and terazosin are appropriate treatment options for LUTS secondary to BPH.…”

Section: Alpha-blockersmentioning

confidence: 99%

2010 Update: Guidelines for the management of benign prostatic hyperplasia

Nickel

Méndez-Probst

Whelan

et al. 2013

CUAJ

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The Efficacy of Drugs for the Treatment of LUTS/BPH, A Study in 6 European Countries

Cited by 106 publications

References 23 publications

Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries

Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries

The effects of combination therapy with dutasteride plus tamsulosin on clinical outcomes in men with symptomatic BPH: 4-year post hoc analysis of European men in the CombAT study

2010 Update: Guidelines for the management of benign prostatic hyperplasia

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