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Terazosin for treating symptomatic benign prostatic obstruction: a systematic review of efficacy and adverse effects.

Abstract

OBJECTIVE

To systematically review and evaluate the effectiveness and adverse effects of the alpha-antagonist, terazosin, for treating urinary symptoms associated with benign prostatic obstruction (BPO).

METHODS

Studies were sought and included in the review if they were randomized trials of at least 1 month duration, involved men with symptomatic BPO and compared terazosin with placebo or active controls. The study, patient characteristics and outcome data were extracted in duplicate onto standardized forms using a prospectively developed protocol.

RESULTS

Seventeen studies involving 5151 men met the inclusion criteria, i.e. placebo-controlled (10), alpha-blockers (seven), finasteride alone or combined with terazosin and placebo (one), and microwave therapy (one). The study duration was 4-52 weeks; the mean age of the men was 65 years and 82% were white. Baseline urological symptom scale scores and flow rates showed that men had moderate BPO. Efficacy outcomes were rarely reported in a way that allowed for data pooling, but indicated that terazosin improved symptom scores and flow rates more than did placebo or finasteride, and similarly to other alpha-antagonists. The pooled mean percentage improvement for the Boyarsky symptom score was 37% for terazosin and 15% for placebo (four studies). The mean percentage improvement for the American Urological Association symptom score was 38%, compared with 17% and 20% for placebo and finasteride, respectively (two studies). The pooled mean improvement in the International Prostate Symptom Score of 40% was similar to that with tamsulosin (43%). Peak urinary flow rates improved more with terazosin (22%) than with placebo (11%) and finasteride (15%), but did not differ significantly from the other alpha-antagonists. The percentage of men discontinuing terazosin was comparable with those receiving placebo and finasteride, but greater than with other alpha-antagonists. Adverse effects were greater than with placebo and included dizziness, asthenia, headache and postural hypotension.

CONCLUSIONS

The available evidence indicates that terazosin improves the symptoms and flow rates associated with BPO; it was more effective than placebo or finasteride and similar to other alpha-antagonists. Adverse effects were generally mild but more frequent than with other alpha-antagonists and associated with a two- to four-fold increase in treatment discontinuation.

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  • Authors+Show Affiliations

    ,

    Minneapolis VA Center for Chronic Disease Outcomes Research, the Cochrane Review Group in Prostate Diseases and Urologic Cancers, VA Medical Center, Minneapolis, USA. tim.wilt@med.va.gov

    ,

    Source

    BJU international 89:3 2002 Feb pg 214-25

    MeSH

    Adrenergic alpha-Antagonists
    Aged
    Drug Combinations
    Enzyme Inhibitors
    Finasteride
    Humans
    Male
    Patient Dropouts
    Prostatic Hyperplasia
    Quality of Life
    Randomized Controlled Trials as Topic
    Sulfonamides
    Tamsulosin
    Urinary Retention
    Urination

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    11856101

    Citation

    Wilt, T J., et al. "Terazosin for Treating Symptomatic Benign Prostatic Obstruction: a Systematic Review of Efficacy and Adverse Effects." BJU International, vol. 89, no. 3, 2002, pp. 214-25.
    Wilt TJ, Howe W, MacDonald R. Terazosin for treating symptomatic benign prostatic obstruction: a systematic review of efficacy and adverse effects. BJU Int. 2002;89(3):214-25.
    Wilt, T. J., Howe, W., & MacDonald, R. (2002). Terazosin for treating symptomatic benign prostatic obstruction: a systematic review of efficacy and adverse effects. BJU International, 89(3), pp. 214-25.
    Wilt TJ, Howe W, MacDonald R. Terazosin for Treating Symptomatic Benign Prostatic Obstruction: a Systematic Review of Efficacy and Adverse Effects. BJU Int. 2002;89(3):214-25. PubMed PMID: 11856101.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Terazosin for treating symptomatic benign prostatic obstruction: a systematic review of efficacy and adverse effects. AU - Wilt,T J, AU - Howe,W, AU - MacDonald,R, PY - 2002/2/22/pubmed PY - 2002/3/23/medline PY - 2002/2/22/entrez SP - 214 EP - 25 JF - BJU international JO - BJU Int. VL - 89 IS - 3 N2 - OBJECTIVE: To systematically review and evaluate the effectiveness and adverse effects of the alpha-antagonist, terazosin, for treating urinary symptoms associated with benign prostatic obstruction (BPO). METHODS: Studies were sought and included in the review if they were randomized trials of at least 1 month duration, involved men with symptomatic BPO and compared terazosin with placebo or active controls. The study, patient characteristics and outcome data were extracted in duplicate onto standardized forms using a prospectively developed protocol. RESULTS: Seventeen studies involving 5151 men met the inclusion criteria, i.e. placebo-controlled (10), alpha-blockers (seven), finasteride alone or combined with terazosin and placebo (one), and microwave therapy (one). The study duration was 4-52 weeks; the mean age of the men was 65 years and 82% were white. Baseline urological symptom scale scores and flow rates showed that men had moderate BPO. Efficacy outcomes were rarely reported in a way that allowed for data pooling, but indicated that terazosin improved symptom scores and flow rates more than did placebo or finasteride, and similarly to other alpha-antagonists. The pooled mean percentage improvement for the Boyarsky symptom score was 37% for terazosin and 15% for placebo (four studies). The mean percentage improvement for the American Urological Association symptom score was 38%, compared with 17% and 20% for placebo and finasteride, respectively (two studies). The pooled mean improvement in the International Prostate Symptom Score of 40% was similar to that with tamsulosin (43%). Peak urinary flow rates improved more with terazosin (22%) than with placebo (11%) and finasteride (15%), but did not differ significantly from the other alpha-antagonists. The percentage of men discontinuing terazosin was comparable with those receiving placebo and finasteride, but greater than with other alpha-antagonists. Adverse effects were greater than with placebo and included dizziness, asthenia, headache and postural hypotension. CONCLUSIONS: The available evidence indicates that terazosin improves the symptoms and flow rates associated with BPO; it was more effective than placebo or finasteride and similar to other alpha-antagonists. Adverse effects were generally mild but more frequent than with other alpha-antagonists and associated with a two- to four-fold increase in treatment discontinuation. SN - 1464-4096 UR - https://www.unboundmedicine.com/medline/citation/11856101/Terazosin_for_treating_symptomatic_benign_prostatic_obstruction:_a_systematic_review_of_efficacy_and_adverse_effects_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1464-4096&date=2002&volume=89&issue=3&spage=214 DB - PRIME DP - Unbound Medicine ER -