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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 林志杰 | 一個前瞻性隨機分布比較型研究︰如何針對以儲尿型下泌尿道症狀為主的男性來選擇第一線用藥 | 2015/5/29 下午 04:16:44 | 0 |
| 原 文 | 題 目 | How to choose first-line treatment for men with predominant storage lower urinary tract symptoms: a prospective randomised comparative study. |
| 作 者 | 廖俊厚主任、郭漢崇主任 | |
| 出 處 | International journal of Clinical Practice,69,1, 124–130. | |
| 出版日期 | January 2015 | |
| 評 論 | 對以阻塞性症狀為主的男性在用藥選擇常是比較沒有疑慮，但是針對以儲尿型症狀為主的男性，常會面臨在第一線給藥時，考量其治療效果及副作用。所以若是單以甲型阻斷劑或是抗乙醯膽鹼藥物來作第一線治療的成效如何，此篇文章是廖主任將此類病患作隨機性分佈的研究，來提供臨床醫師治療參考。而參與此研究的病患皆為大於40歲的男性且國際攝護腺症狀指數的總分要大於8分，而且儲尿型症狀分數須大於阻塞型症狀的分數，排尿後餘尿小於250西西。病患隨機分布在兩個治療組，一為doxazosin 4豪克，另一組為tolterodine 4豪克，治療期為12週。研究共有163個病患，這兩組的病患在治療一個月後的評估發現有約七成的人達到改善。針對這兩組治療失敗的病患來分析發現，在tolterodine組的病患有比較高分的儲尿型症狀和排尿間斷，至於另一組以doxazosin治療失敗的病患則是在急尿症狀的部份是比較嚴重的。此研究的結論是針對男性儲尿型症狀較嚴重的病患，若是考慮以單一藥物來作第一線治療，甲型阻斷劑建議給那些有較高阻塞性症狀的病患，而抗乙醯膽鹼藥物則是給予那些有較嚴重急尿症狀且較小攝護腺的病患。 | |
| abstract |
Aims: To compare the therapeutic effects and identify predictors of successful treatment of first-line antimuscarinic and a-blocker monotherapy for men with predominant storage lower urinary tract symptoms (LUTS). Methods: This prospective randomised comparative study included men aged ≥ 40 years with a total IPSS ≥ 8, IPSS storage subscore (IPSS-S) ≥ voiding subscore (IPSS-V) and PVR ≤ 250 ml. Subjects were randomised to receive tolterodine 4 mg or doxazosin 4 mg daily for 12 weeks. The primary end-point included changes of total IPSS, IPSS subscore and global response assessment (GRA) after treatment. The secondary end-points included comparisons of baseline parameters between patients with a GRA ≥ 1 and GRA < 1. All adverse events were also recorded. Results: This study was completed by 163 patients. The IPSS-T, IPSS-S and quality of life index decreased significantly in both groups. An improved outcome (GRA ≥ 1) at 4 weeks was reported in 51/74 patients (68.9%) receiving doxazosin and 69/89 patients (77.5%) receiving tolterodine. The rate of improved outcome in patients with a TPV < 40 ml was significantly higher in tolterodine group (73.3% vs. 57.6%, p = 0.040). Patients with tolterodine treatment failure (GRA < 1) had higher baseline IPSS-V and IPSS intermittency domain, as patients with doxazosin treatment failure had a higher baseline IPSS urgency domain. Conclusions: The rate of improved outcome was comparable between first-line tolterodine and doxazosin monotherapy for male storage LUTS. Antimuscarinic monotherapy was suggested for men with smaller prostate volume and higher urgency symptom scores, as a-blocker monotherapy was suggested for those with higher voiding symptom scores. |
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