-blocker doxazosin, the 5--reductase inhibitor finasteride,
both drugs, or double placebo.Although doxazosin reduced the number of nightly episodes, the change was modest.
Some men with benign prostatic hyperplasia (BPH)
find nocturia to be their most troublesome symptom, because it interferes with
sleep. To determine the effect of BPH drug therapies on nocturia, researchers
performed an additional analysis of data from the previously published MTOPS
randomized trial (Journal
Watch Jan 13 2004). In that 4-year trial, 3000 men with symptomatic BPH
received the -blocker doxazosin, the 5--reductase inhibitor finasteride,
both drugs, or double placebo.
At baseline, men with nocturia reported an average of 2.3 episodes nightly. During follow-up, doxazosin recipients averaged 0.2 fewer nocturia episodes nightly than did placebo recipients — a significant difference. In contrast, finasteride was no better than placebo, and combined therapy was no better than doxazosin monotherapy. The reduction in nocturia with doxazosin was confined mostly to men older than 70 (whose nocturia had decreased by a mean of 0.5 episodes nightly at 4 years). The proportions of patients who reported decreases of at least one episode nightly were 47% in the doxazosin group and 36% in the placebo group; the 11% difference shows that nine patients must be treated to achieve one response.
Comment:
Doxazosin (and presumably other -blockers) can reduce nocturia
in men with BPH, but the reduction is less impressive than one might expect.
Whether the effect is more substantial in men with more-severe symptoms is
unclear: In this study, only 15% of patients had four or more episodes of
nocturia nightly.
Published in Journal Watch General Medicine November 8, 2007
Johnson TM II et al. The effect of doxazosin, finasteride and combination therapy on nocturia in men with benign prostatic hyperplasia. J Urol 2007 Nov; 178:2045.