Evaluation of the Effectiveness of Terazosin, Tamsulosin and Finasteride for Benign Prostatic Hyperplasia_Chinese Journal of Evidence-Based Medicine

Authors：

XIONG Ying ¹² , YE Lu ² , REN Yu ² , LI Yi ² , SONG Hao ² , LI Ningning ² , CHU Zhengzheng ² , LI Youping ¹

1. Chinese Evidence-Based Medicine Center; West China Hospital; Sichuan University; Chengdu 610041; China2. West China Clinical Medical School; Sichuan Universit y;

Corresponding author：

Keywords：

Benign prostatic hyperplasia; Terazosin; Tamsulosin; Finasteride; Effectiv eness; Systematic review

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Objective 　To evaluate the effectiveness of terazosin, tamsulosin and finasteride for benign prostatic hyperplasia (BPH).
Methods 　We searched the related original studies all over the world, and only included randomized controlled trials (RCT) and quasi-randomized controlled trials (CCT). MEDLINE (1966 to Dec. 2004), EMBASE (1984 to Dec. 2004), The Cochrane Library (Issue 4, 2004) and four Chinese databases were electronically searched and 10 related journals were handsearched. The studies included in the references of eligible studies were additionally searched. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. Divergences of opinion were consulted by a third party. Meta-analysis was performed by using RevMan 4.2 software.
Results 　Twelve original studies involving 2 471 participants met inclusion criteria. Compared with terazosin, tamsulosin could improve international prostatic symptom score, with WMD 0.75, 95% confidence interval (CI) 0.03 to 1.46, P=0.04. There was no statistical difference between terazosin and tamsulosin in improving the average rate of urine flow (WMD 0.23, 95%CI -0.39 to 0.85, P=0.46), the residual urine volume (WMD 0.82, 95%CI -2.92 to 4.57, P=0.67) and in diminishing the volume of prostate (WMD 2.20, 95%CI -3.99 to 8.39, P=0.49). There was no statistical difference between finasteride and tamsulosin in improving the international prostatic symptom score (WMD 0.65, 95%CI -0.45 to 1.75, P=0.25) or the max rate of urine flow (WMD 0.39, 95%CI -0.72 to 1.51, P=0.49). Only two studies compared finasteride with terazosin and had different conclusions. Only one study compared finasteride or terazosin with a combination of these drugs suggested that the combination had higher effective power than finasteride alone but no difference with terazosin alone.
Conclusions 　Although the effectiveness in some aspects is higher in the tamsulosin group, there is not enough evidence to show which one is the best among these three drugs. The combination of finasteride and terazosin does not show more effectiveness than terazosin alone. This review suggests that tamsulosin alone should be used for the treatment of BPH and the combination needs to be identified by better evidence. It is important to improve the quality of original studies.

Citation： XIONG Ying,YE Lu,REN Yu,LI Yi,SONG Hao,LI Ningning,CHU Zhengzheng,LI Youping. Evaluation of the Effectiveness of Terazosin, Tamsulosin and Finasteride for Benign Prostatic Hyperplasia. Chinese Journal of Evidence-Based Medicine, 2005, 05(6): 448-454. doi: Copy

1.	王健, 齐晓涟, 张乃文. 近期良性前列腺增生症药物治疗及不良反应进展[J]. 中国全科医学, 2004; 7(11): 823～825.
2.	熊礼生. 前列腺增生症的药物治疗[J]. 实用医学杂志, 2001; 17(1): 6-7.
3.	邹声泉, 龚建平. 外科学--前沿与争论[M]. 第1版. 北京: 人民卫生出版社, 2003.
4.	钟惟德, 蔡岳斌, 胡建波, 王良圣, 魏鸿蔼, 余安迪. α1受体阻滞剂治疗前列腺增生症的疗效-成本分析[J]. 广东药学院学报, 2000; 16(2): 135～137.
5.	许锡荣, 钟惟德, 王良圣, 魏鸿蔼, 余安迪. 特拉唑嗪、高特灵、哈乐治疗前列腺增生症费用疗效分析[J]. 实用医学杂志, 2000; 16(10): 816～817.
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9.	蔡岳斌. 前列腺增生症三种药物治疗方案的费用效果分析[J]. 广州医学院学报, 2001; 29(2): 85～86.
10.	李凤阁, 王素如. 非那雄胺治疗前列腺增生症47例[J]. 医药导报, 1999; 18(5): 324.
11.	Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age[J]. J Urol, 1984; 132(3): 474-479.
12.	Wang J, Qi XL, Zhang NW. Advancement of drug treatment for benign prostatic hyperplasia[J]. Chinese General Practice, 2004; 7(11): 823-825.
13.	Xiong LS. Drug treatment for benign prostatic hyperplasia[J]. The Journal of Practical Medicine, 2001; 17(1): 6-7.
14.	Zou SQ, Gong JP. Surgery-front and argument[M]. 1st ed. Beijing: People’s Medical Publishing House, 2003.
15.	Okada H, Kamidono S, Yoshioka T, Okuyama A, Ozono S, Hirao Y, Okajima E, Yamamoto K, Kishimoto T, Park Y, Kurita T. A comparative study of terazosin and tamsulosin for symptomatic benign prostatic hyperplasia in Japanese patients[J]. BJU Int, 2000; 85(6): 676-681.
16.	Lee E, Lee C. Clinical comparison of selective and non-selective alpha 1A-adrenoreceptor antagonists in benign prostatic hyperplasia: studies on tamsulosin in a fixed dose and terazosin in increasing doses[J]. Br J Urol, 1997; 80(4): 606-611.
17.	Tsujii T. Comparison of prazosin, terazosin and tamsulosin in the treatment of symptomatic benign prostatic hyperplasia: a short-term open, randomized multicenter study. BPH Medical Therapy Study Group. Benign prostatic hyperplasia[J]. Int J Urol, 2000; 7(6): 199-205.
18.	Zhong WD, Cai YB, Hu JB, Wang LS, Wei HA, Yu AD. Effective-cost analysis of alpha 1-adrenoceptor antagonist for benign prostatic hyperplasia[J]. Academic Journal of Guangdong College of Pharmacy, 2000; 16(2): 135-137.
19.	Xu XR, Zhong WD, Wang LS, Wei HA, Yu AD. Effective-cost analysis of terazosin, hytrin and harnal for benign prostatic hyperplasia[J]. The Journal of Practical Medicine, 2000; 16(10): 816-817.
20.	Na YQ, Wang D, Jin J, Guo YL, Xue ZY, Gu FL. Selective alpha 1a-adrenoceptor antagonist for benign prostatic hyperplasia[J]. Chinese Journal of Urology, 1996; 6(17): 327-329.
21.	Jin L. Effective of two selective alpha-adrenoceptor antagonist for benign prostatic hyperplasia[J]. Jiangsu Pharmaceutical and Clinical Research, 1999; 7(1): 31-32.
22.	Lee E. Comparison of tamsulosin and finasteride for lower urinary tract symptoms associated with benign prostatic hyperplasia in Korean patients[J]. J Int Med Res. 2002; 30(6): 584-590.
23.	Wang Y, Wan JQ. Different drugs for benign prostatic hyperplasia[J]. Chinese Pharmaceutical Affairs, 2003; 17(8): 525-526.
24.	Cai YB. Cost-effectiveness analysis of three therapeutic schemes for benign prostatic hypertrophy[J]. Academic Journal of Guangzhou Medical College, 2001; 29(2): 85-86.
25.	Li FG, Wang SR. Finasteride for benign prostatic hyperplasia-47 cases reports[J]. Herald of Medicine, 1999; 18(5): 324.
26.	Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G, Haakenson C, Machi M, Narayan P, Padley RJ. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group[J]. N Engl J Med, 1996; 335(8): 533-539.

1. 王健, 齐晓涟, 张乃文. 近期良性前列腺增生症药物治疗及不良反应进展[J]. 中国全科医学, 2004; 7(11): 823～825.
2. 熊礼生. 前列腺增生症的药物治疗[J]. 实用医学杂志, 2001; 17(1): 6-7.
3. 邹声泉, 龚建平. 外科学--前沿与争论[M]. 第1版. 北京: 人民卫生出版社, 2003.
4. 钟惟德, 蔡岳斌, 胡建波, 王良圣, 魏鸿蔼, 余安迪. α1受体阻滞剂治疗前列腺增生症的疗效-成本分析[J]. 广东药学院学报, 2000; 16(2): 135～137.
5. 许锡荣, 钟惟德, 王良圣, 魏鸿蔼, 余安迪. 特拉唑嗪、高特灵、哈乐治疗前列腺增生症费用疗效分析[J]. 实用医学杂志, 2000; 16(10): 816～817.
6. 那彦群, 汪迪, 金杰, 郭应禄, 薛兆英, 顾方六. 选择性α1a受体阻断剂治疗前列腺增生症[J]. 中华泌尿外科杂志, 1996; 6(17): 327-329.
7. 金兰. 两种选择性α受体阻断剂在治疗前列腺增生症中的疗效比较[J]. 江苏药学与临床研究, 1999; 7(1): 31～32.
8. 王彦, 苑记清. 不同药物治疗前列腺增生症[J]. 中国药事, 2003; 17(8): 525～526.
9. 蔡岳斌. 前列腺增生症三种药物治疗方案的费用效果分析[J]. 广州医学院学报, 2001; 29(2): 85～86.
10. 李凤阁, 王素如. 非那雄胺治疗前列腺增生症47例[J]. 医药导报, 1999; 18(5): 324.
11. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age[J]. J Urol, 1984; 132(3): 474-479.
12. Wang J, Qi XL, Zhang NW. Advancement of drug treatment for benign prostatic hyperplasia[J]. Chinese General Practice, 2004; 7(11): 823-825.
13. Xiong LS. Drug treatment for benign prostatic hyperplasia[J]. The Journal of Practical Medicine, 2001; 17(1): 6-7.
14. Zou SQ, Gong JP. Surgery-front and argument[M]. 1st ed. Beijing: People’s Medical Publishing House, 2003.
15. Okada H, Kamidono S, Yoshioka T, Okuyama A, Ozono S, Hirao Y, Okajima E, Yamamoto K, Kishimoto T, Park Y, Kurita T. A comparative study of terazosin and tamsulosin for symptomatic benign prostatic hyperplasia in Japanese patients[J]. BJU Int, 2000; 85(6): 676-681.
16. Lee E, Lee C. Clinical comparison of selective and non-selective alpha 1A-adrenoreceptor antagonists in benign prostatic hyperplasia: studies on tamsulosin in a fixed dose and terazosin in increasing doses[J]. Br J Urol, 1997; 80(4): 606-611.
17. Tsujii T. Comparison of prazosin, terazosin and tamsulosin in the treatment of symptomatic benign prostatic hyperplasia: a short-term open, randomized multicenter study. BPH Medical Therapy Study Group. Benign prostatic hyperplasia[J]. Int J Urol, 2000; 7(6): 199-205.
18. Zhong WD, Cai YB, Hu JB, Wang LS, Wei HA, Yu AD. Effective-cost analysis of alpha 1-adrenoceptor antagonist for benign prostatic hyperplasia[J]. Academic Journal of Guangdong College of Pharmacy, 2000; 16(2): 135-137.
19. Xu XR, Zhong WD, Wang LS, Wei HA, Yu AD. Effective-cost analysis of terazosin, hytrin and harnal for benign prostatic hyperplasia[J]. The Journal of Practical Medicine, 2000; 16(10): 816-817.
20. Na YQ, Wang D, Jin J, Guo YL, Xue ZY, Gu FL. Selective alpha 1a-adrenoceptor antagonist for benign prostatic hyperplasia[J]. Chinese Journal of Urology, 1996; 6(17): 327-329.
21. Jin L. Effective of two selective alpha-adrenoceptor antagonist for benign prostatic hyperplasia[J]. Jiangsu Pharmaceutical and Clinical Research, 1999; 7(1): 31-32.
22. Lee E. Comparison of tamsulosin and finasteride for lower urinary tract symptoms associated with benign prostatic hyperplasia in Korean patients[J]. J Int Med Res. 2002; 30(6): 584-590.
23. Wang Y, Wan JQ. Different drugs for benign prostatic hyperplasia[J]. Chinese Pharmaceutical Affairs, 2003; 17(8): 525-526.
24. Cai YB. Cost-effectiveness analysis of three therapeutic schemes for benign prostatic hypertrophy[J]. Academic Journal of Guangzhou Medical College, 2001; 29(2): 85-86.
25. Li FG, Wang SR. Finasteride for benign prostatic hyperplasia-47 cases reports[J]. Herald of Medicine, 1999; 18(5): 324.
26. Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G, Haakenson C, Machi M, Narayan P, Padley RJ. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group[J]. N Engl J Med, 1996; 335(8): 533-539.

Chinese Journal of Evidence-Based Medicine

Evaluation of the Effectiveness of Terazosin, Tamsulosin and Finasteride for Benign Prostatic Hyperplasia

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