Effects of Temporary Drug Cessation in BPH/LUTS Patients Treated with Alpha-1 Adrenoceptor Blocker
Published on: 2019-01-30
Objective: Patients with benign prostatic hyperplasia (BPH) typically present with lower urinary tract symptoms (LUTS). We sought to confirm the safety and clinical efficacy of the α-1 blocker silodosin, and investigated the effects of a temporary drug cessation (DC) in patients who exhibited clinical efficacy considered as improvement of subjective symptoms. Methods: Subjects were 75 BPH patients with complaints of LUTS and who were being treated on an outpatient basis. Patients were first administered silodosin (4 mg twice daily) for 8 weeks, and then we evaluated the effects based on changes in subjective symptoms and divided the subjects into continuous administration (CA) and DC groups. The groups were followed up until week 24. Silodosin administration was restarted according to subjects’ request during drug cessation (R group). We evaluated the International Prostatic Symptom Score (I-PSS) and quality of life (QOL) score trends before and after administration, and also assessed the safety and status of drug re-administration. Results: Significant differences were observed between the two groups in terms of the subject characteristics of age, I-PSS storage symptoms sub-score, maximum urinary flow rate, and mean urinary flow rate. The clinical course of the voiding and storage symptoms in the CA group differed; storage symptoms improved over time, while no further improvement in the voiding symptoms was observed over time. Symptoms rapidly improved after silodosin administration in the DC group, and the improvement in I-PSS was maintained after DC. However, the residual effects on QOL gradually diminished in this group. The deterioration in voiding symptoms was particularly conspicuous in those who restarted drug administration. Conclusion: DC was possible in patients who experienced adequate improvement in storage symptoms from the early stages of α-1 blocker administration. However, we believe that it is important for elderly patients and patients with relatively severe storage symptoms to continue oral intake of α-1 blockers to maintain improved QOL.