Meta-analysis of randomized trials of terazosin in the treatment of benignprostatic hyperplasia

Objectives. To determine the effectiveness of the long-acting alpha(1)-adre nergic receptor blocking agent terazosin compared with placebo on lower uri nary tract symptoms and peak urinary flow rate in men with clinical benign prostatic hyperplasia. Methods. A formal meta-analysis of all nine randomized trials of terazosin using both an Empirical Bayes and a fully Bayesian approach was conducted. A pooled analysis was conducted on those studies in which patients had a ba seline assessment of prostate volume by transrectal ultrasonography. Results. No evidence of heterogeneity was found in the estimated effects of terazosin on the change in peak flow rates in the studies. Terazosin treat ment was associated with an increase in the peak flow rate of 1.4 mL/s (95% confidence interval [1.0, 1.7]) compared with placebo. Terazosin resulted in an average reduction of 2.2 points over placebo (95% confidence interval [1.6, 3.0]) regarding the common symptom score (range 0 to 36 points). A m ild heterogeneity was found across the studies, with the decrease in sympto m score slightly greater with longer treatment duration. No evidence was fo und that the baseline prostate volume influenced the effect of terazosin. Conclusions. Terazosin was effective and superior to placebo in reducing sy mptoms and increasing the peak urinary flow rate. The effect of terazosin o n the peak: urinary flow rate was apparent in studies as short as 8 weeks. Most importantly, the effect of terazosin on Symptoms and peak urinary flow rate was independent of the baseline prostate size for the range of prosta te volumes reported. (C) 2001, Elsevier Science Inc.