The efficacy and safety of alpha-1 blockers for benign prostatic hyperplasia: An overview of 15 systematic reviews

Objective: A great number of clinical trials and systematic reviews have evaluated the efficacy and safety of α1 blockers for benign prostatic hyperplasia (BPH). We carried out an overview of reviews to provide an up-to-date summary of evidence regarding the efficacy and safety between different α1 blockers for BPH. Research design and methods: PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database and VIP were searched for eligible studies. Direct evidence was analyzed narratively. We used a random-effects model within a Bayesian framework to calculate indirect estimates if no direct evidence existed. The GRADE approach was used in summarizing conclusions. Results: A total of 15 systematic reviews involving five α1 blockers met the inclusion criteria. Direct evidence demonstrated that α1 blockers were superior to placebo in reducing urinary symptom scores and improving peak urinary flow PUF. Doxazosin could significantly reduce urinary symptom scores compared with tamsulosin mean difference (MD-1.60, 95% CI-1.80 to-1.40) and alfuzosin (MD1.7, 95% CI 0.76-1.64). Indirect evidence suggested that the urinary symptom score and PUF at endpoint in men treated with naftopidil were similar to those treated with other α1 blockers. α1 Blockers generally lead to more adverse effects compared with placebo, and those caused by terazosin were more frequent than others. Conclusions: α1 Blockers are more effective than placebo for BPH, doxazosin and tamsulosin seem to be more effective than other α1 blockers. The adverse effects caused by α1 blockers are generally mild and well-tolerated.