Alpha blocker monotherapy versus combination therapy with antimuscarinics in men with persistent LUTS refractory to alpha-adrenergic treatment: patterns of persistence

Can J Urol. 2015 Aug;22(4):7914-23.


Introduction: Patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) often present with voiding and storage symptoms, which may require combination therapy with an alpha blocker and an antimuscarinic (AM). This study compared treatment persistence in LUTS/BPH patients on alpha blocker monotherapy with those using combination alpha blocker and AM therapy (AB/AM).

Materials and methods: Retrospective analysis of anonymized patient longitudinal prescription reimbursement claims data. All patients who had claims for any of four alpha blocker medications and six AM agents during an index period from April 1, 2011 to March 31, 2012 were included. For the combination therapy group, the effect of adherence with the AM medication on persistence to the alpha blocker was examined.

Results: Patients on AB/AM combination therapy remained on alpha blockers for longer than those on alpha blocker monotherapy (p = 0.04); 92.4% were persistent at 3 months versus 89.0%, and at 1 year 50.8% were persistent versus 49.6%, respectively. The highest number of days on therapy was reported for tamsulosin plus solifenacin. As confirmed by multivariate analysis, patients with the highest adherence to AM medication (= 80%) persisted on alpha blockers for longer than those with the lowest (< 50%) adherence (p < 0.05).

Conclusions: Patients taking an AM in combination with an alpha blocker showed greater persistence with alpha blocker treatment over a 1 year period. When an AM is combined with an alpha blocker in patients with LUTS/BPH, the additional medication burden does not have a negative impact on persistence and may even improve it.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administrative Claims, Healthcare
  • Adrenergic alpha-Antagonists / therapeutic use*
  • Aged
  • Benzofurans / therapeutic use
  • Doxazosin / therapeutic use
  • Drug Therapy, Combination / methods
  • Humans
  • Longitudinal Studies
  • Male
  • Mandelic Acids / therapeutic use
  • Medication Adherence*
  • Middle Aged
  • Muscarinic Antagonists / therapeutic use*
  • Ontario
  • Prazosin / analogs & derivatives
  • Prazosin / therapeutic use
  • Prostatic Hyperplasia / complications
  • Prostatism / drug therapy*
  • Prostatism / etiology
  • Pyrrolidines / therapeutic use
  • Quinazolines / therapeutic use
  • Retrospective Studies
  • Solifenacin Succinate / therapeutic use
  • Sulfonamides / therapeutic use
  • Tamsulosin
  • Tolterodine Tartrate / therapeutic use


  • Adrenergic alpha-Antagonists
  • Benzofurans
  • Mandelic Acids
  • Muscarinic Antagonists
  • Pyrrolidines
  • Quinazolines
  • Sulfonamides
  • Tolterodine Tartrate
  • Terazosin
  • alfuzosin
  • darifenacin
  • Tamsulosin
  • oxybutynin
  • Solifenacin Succinate
  • Doxazosin
  • Prazosin