Current Pharmacological Treatment for Male LUTS due to BPH: Dutasteride or Finasteride?
Current Pharmacological Treatment for Male LUTS due to BPH: Dutasteride or Finasteride?
复制标题
DOI：
10.2174/1389450116666150518101617
复制
发表时间：
2015-01-01
影响因子：
3.2
通讯作者：
Cindolo, Luca
中科院分区：
文献类型：
--
作者：
Pirozzi, Luisella;Sountoulides, Petros;Cindolo, Luca
良性前列腺增生（BPH）是一种潜在的进行性疾病，通常与令人烦恼的下尿路症状（LUTS）相关，并可能导致并发症，如急性尿潴留和BPH相关手术。在目前用于BPH引起的LUTS的药物治疗方案中，只有一类药物，即5-α还原酶抑制剂（5ARI），已被发现可有效降低疾病进展的风险。目前可用的两种5ARI包括芬那雄胺和度他雄胺。这两种药物具有不同的药代动力学和药效学特性。度他雄胺对脱氢睾酮的抑制作用更强（>90%度他雄胺vs 70%非那雄胺），理论上这与缓解泌尿系统症状的更大疗效相关。不幸的是，这一假设尚未在临床上得到证实。相关的文献稀少，种类繁多，产生的证据科学水平低。本综述文章旨在评价头对头比较研究，以评价度他雄胺和非那雄胺之间是否存在假设的临床差异。任何一种药物的药理学治疗都能导致类似的症状改善;然而，度他雄胺似乎在降低前列腺手术和急性尿潴留（AUR）风险方面具有更好的特征。需要更多的研究来更好地评估这两种5ARI的临床和药物经济学特征。
Benign prostatic hyperplasia (BPH) is a potentially progressive disease which is commonly associated with bothersome lower urinary tract symptoms (LUTS) and might result in complications, such as acute urinary retention and BPH-related surgery. In the current medical therapy scenario for LUTS attributed to BPH, only one class of drugs, 5-alpha reductase inhibitors (5ARIs), has been found to be effective in reducing the risk of disease progression. The two 5ARIs that are currently available include finasteride and dutasteride. These two drugs have different pharmacokinetic and pharmacodynamic properties. Greater suppression of dehydrotestosterone is achieved by dutasteride (>90% dutasteride vs 70% finasteride) which theoretically should correlate with greater efficacy in alleviating urinary symptoms. Unfortunately, this hypothesis has not yet been clinically demonstrated. The pertinent literature is scarce and heterogeneous and produces low scientific levels of evidence. The present review article aims to evaluate the comparative head-to-head studies in order to evaluate if the hypothetical clinical differences between dutasteride and finasteride do exist. Pharmacological treatment with either drug results in similar symptom improvements; however dutasteride seems to have a better profile in reducing the risk of prostate surgery and acute urinary retention (AUR). More studies are necessary to better evaluate both the clinical and pharmacoeconomic profile of the two 5ARIs.