CME Author: Désirée Lie, MD, MSEd
January 10, 2011 — In patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), antibiotics and α-blockers improve total symptom, pain, voiding, and quality-of-life scores vs placebo, according to the findings of a recent systematic review and network meta-analysis.
Thunyarat Anothaisintawee, MD, with the Ramathibodi Hospital and Mahidol University, in Bangkok, Thailand, and colleagues reported their findings in the January 5 issue of the Journal of the American Medical Association.
According to the researchers, antibiotics, α-blockers, and combination therapies of the two "appear to improve all clinical symptom scores compared with placebo, while anti-inflammatory drugs, finasteride, and phytotherapies have a lesser but measureable effect on select variables (ie, pain, voiding symptoms, and treatment response rate, respectively)."
The current analysis was designed to compare the clinical symptom scores and response rates of α-blockers with other therapies vs placebo in CP/CPPS, and included 23 studies in the systematic review and network meta-analysis.
With use of standardized mean differences, α-blockers were associated with improved symptoms, including total symptom scores (−1.7; 95% confidence interval [CI], −2.8 to −0.6), pain scores (−1.1; 95% CI, −1.8 to −0.3), voiding scores (−1.4; 95% CI, −2.3 to −0.5), and quality-of-life scores (−1.0; 95% CI, −1.8 to −0.2) vs placebo. Similarly, the network meta-analysis showed that antibiotics decreased total symptom scores (−9.8; 95% CI, −15.1 to −4.6), pain scores (−4.4; 95% CI, −7.0 to −1.9), voiding scores (−2.8; 95% CI, −4.1 to −1.6), and quality-of-life scores (−1.9; 95% CI, −3.6 to −0.2) vs placebo.
Combination therapies of α-blockers and antibiotics also yielded similar results, with reduced total symptom scores (−13.8; 95% CI, −17.5 to −10.2), pain scores (−5.7; 95% CI, −7.8 to −3.6), voiding scores (−3.7; 95% CI, −5.2 to −2.1), and quality-of-life scores (−2.8; 95% CI, −4.7 to −0.9) vs placebo.
Furthermore, treatment response rates were greatest for α-blockers (pooled relative risk [RR], 1.6; 95% CI, 1.1 - 2.3) and anti-inflammatory drugs (pooled RR, 1.8; 95% CI, 1.2 - 2.6).
"Our review suggests that α-blockers, antibiotics, or combinations of both are most appropriate for therapy of CP/CPPS, particularly for patients with voiding symptoms," Dr. Anothaisintawee and colleagues conclude.
Despite these encouraging findings, the researchers report a publication bias for smaller studies of α-blockers, which likely increased the magnitude of positive findings involving this treatment.
They also recommend anti-inflammatory medications for patients with pain. "While finasteride and phytotherapy may provide benefit to some patients, these therapies require more evaluation, perhaps in selected subgroups of CP/CPPS patients," the researchers suggest.
The study was funded in part by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, the Canada Institute for Health Research, and the Canada Research Chair Program. The study authors have disclosed no relevant financial relationships.
JAMA. 2011;305:78-86. Abstract
regards, taniafdi ^_^
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