Meta-Analysis of the Efficacy and Safety of Imidafenacin for Overactive Bladder Induced by Benign Prostatic Hyperplasia in Men Receiving Alpha-Blocker Therapy

Overview

Journal Int Neurourol J

Date 2021 Jan 6

PMID 33401358

Citations 3

Authors

Tong Cai

Ning Wang

Liye Liang

Zhongbao Zhou

Yong Zhang

Yuanshan Cui

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this meta-analysis was to evaluate the efficacy and safety of imidafenacin for overactive bladder (OAB) induced by benign prostatic hyperplasia (BPH) in men receiving alpha-blocker monotherapy.

Methods: We performed a systematic research of the PubMed, Embase, and Cochrane Library databases, and searched for studies about alpha-blocker with or without imidafenacin treatment for OAB in patients with BPH. We also investigated the original references of the included texts.

Results: Four randomized controlled trials including 779 participants with BPH (389 in the alpha-blocker+imidafenacin group and 390 in the alpha-blocker only group) were studied. The main efficacy endpoint was the Overactive Bladder Symptom Score, which showed a mean difference of -1.88 (95% confidence interval, -2.32 to -1.44; P<0.00001), suggesting that alpha-blocker and imidafenacin treatment was effective in treating men with OAB. As other primary efficacy end points, the International Prostate Symptom Score (IPSS) total score (P=0.47), the IPSS storage symptom score (P=0.07), the IPSS voiding symptom score (P=0.60), and the IPSS quality of life score (P=0.18) indicated that 2 methods had no significant differences in treating men with OAB. In terms of safety, which was assessed using postvoid residual volume (P=0.05) and maximum flow rate (P=0.53), the analysis suggested that combination treatment was very well tolerated.

Conclusion: This study suggested that imidafenacin plus alpha-blocker was an efficacious and safe treatment for OAB symptoms in BPH patients.

Citing Articles

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Reply to Commentary on "Changes in Prevalence and Treatment Pattern of Benign Prostatic Hyperplasia in Korea".

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References

Athanasopoulos A, Gyftopoulos K, Giannitsas K, Fisfis J, Perimenis P, Barbalias G . Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol. 2003; 169(6):2253-6. DOI: 10.1097/01.ju.0000067541.73285.eb. View

Witjes W, de la Rosette J, Donovan J, Peters T, Abrams P, Kay H . The International Continence Society "Benign Prostatic Hyperplasia" Study: international differences in lower urinary tract symptoms and related bother. J Urol. 1997; 157(4):1295-300. DOI: 10.1016/s0022-5347(01)64955-3. View

Lee K, Choo M, Kim D, Kim J, Kim H, Min K . Combination treatment with propiverine hydrochloride plus doxazosin controlled release gastrointestinal therapeutic system formulation for overactive bladder and coexisting benign prostatic obstruction: a prospective, randomized, controlled.... J Urol. 2005; 174(4 Pt 1):1334-8. DOI: 10.1097/01.ju.0000173630.94559.fd. View

Kobayashi F, Yageta Y, Yamazaki T, Wakabayashi E, Inoue M, Segawa M . Pharmacological effects of imidafenacin (KRP-197/ONO-8025), a new bladder selective anti-cholinergic agent, in rats. Comparison of effects on urinary bladder capacity and contraction, salivary secretion and performance in the Morris water maze task. Arzneimittelforschung. 2007; 57(3):147-54. DOI: 10.1055/s-0031-1296598. View

Lepor H . Phase III multicenter placebo-controlled study of tamsulosin in benign prostatic hyperplasia. Tamsulosin Investigator Group. Urology. 1998; 51(6):892-900. DOI: 10.1016/s0090-4295(98)00126-5. View

Nishizawa O, Yamaguchi O, Takeda M, Yokoyama O . Randomized Controlled Trial to Treat Benign Prostatic Hyperplasia with Overactive Bladder Using an Alpha-blocker Combined with Anticholinergics. Low Urin Tract Symptoms. 2015; 3(1):29-35. DOI: 10.1111/j.1757-5672.2010.00081.x. View

Narayan P, Evans C, Moon T . Long-term safety and efficacy of tamsulosin for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. J Urol. 2003; 170(2 Pt 1):498-502. DOI: 10.1097/01.ju.0000076140.68657.fd. View

Yamanishi T, Asakura H, Seki N, Tokunaga S . Efficacy and safety of combination therapy with tamsulosin, dutasteride and imidafenacin for the management of overactive bladder symptoms associated with benign prostatic hyperplasia: A multicenter, randomized, open-label, controlled trial (DIrecT.... Int J Urol. 2017; 24(7):525-531. DOI: 10.1111/iju.13359. View

Kaplan S, McCammon K, Fincher R, Fakhoury A, He W . Safety and tolerability of solifenacin add-on therapy to α-blocker treated men with residual urgency and frequency. J Urol. 2012; 189(1 Suppl):S129-34. DOI: 10.1016/j.juro.2012.11.030. View

10.

Bunniran S, Davis C, Kristy R, Ng D, Schermer C, Uribe C . A prospective study of elderly initiating mirabegron versus antimuscarinics: Patient reported outcomes from the Overactive Bladder Satisfaction Scales and other instruments. Neurourol Urodyn. 2017; 37(1):177-185. DOI: 10.1002/nau.23271. View

11.

Yokoyama O, Tsujimura A, Akino H, Segawa N, Tamada S, Oguchi N . Add-on anticholinergic therapy for residual nocturia in patients with lower urinary tract symptoms receiving α1-blocker treatment: a multi-centre, prospective, randomised study. World J Urol. 2014; 33(5):659-67. PMC: 4555202. DOI: 10.1007/s00345-014-1399-x. View

12.

Gong M, Dong W, Huang G, Gong Z, Deng D, Qiu S . Tamsulosin combined with solifenacin versus tamsulosin monotherapy for male lower urinary tract symptoms: a meta-analysis. Curr Med Res Opin. 2015; 31(9):1781-92. DOI: 10.1185/03007995.2015.1074067. View

13.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

14.

Abrams P, Schulman C, VAAGE S . Tamsulosin, a selective alpha 1c-adrenoceptor antagonist: a randomized, controlled trial in patients with benign prostatic 'obstruction' (symptomatic BPH). The European Tamsulosin Study Group. Br J Urol. 1995; 76(3):325-36. DOI: 10.1111/j.1464-410x.1995.tb07709.x. View

15.

Andersson K, Yoshida M . Antimuscarinics and the overactive detrusor--which is the main mechanism of action?. Eur Urol. 2003; 43(1):1-5. DOI: 10.1016/s0302-2838(02)00540-7. View

16.

Boyle P, Robertson C, Mazzetta C, KEECH M, Hobbs F, Fourcade R . The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int. 2003; 92(4):409-14. DOI: 10.1046/j.1464-410x.2003.04369.x. View

17.

Yamazaki T, Muraki Y, Anraku T . In vivo bladder selectivity of imidafenacin, a novel antimuscarinic agent, assessed by using an effectiveness index for bladder capacity in rats. Naunyn Schmiedebergs Arch Pharmacol. 2011; 384(3):319-29. DOI: 10.1007/s00210-011-0675-1. View

18.

Chapple C, Smith D . The pathophysiological changes in the bladder obstructed by benign prostatic hyperplasia. Br J Urol. 1994; 73(2):117-23. DOI: 10.1111/j.1464-410x.1994.tb07477.x. View

19.

Cho S, Kwon S, Lee K, Yoo T, Shin D, Kim S . A multicenter real-life study of the efficacy of an alpha-blocker with or without anticholinergic agent (imidafenacin) treatment in patients with lower urinary tract symptoms/benign prostatic hyperplasia and storage symptoms. Int J Clin Pract. 2017; 71(5). DOI: 10.1111/ijcp.12938. View

20.

Yokoyama O, Homma Y, Yamaguchi O . Imidafenacin, an antimuscarinic agent, improves nocturia and reduces nocturnal urine volume. Urology. 2013; 82(3):515-20. DOI: 10.1016/j.urology.2013.05.017. View