...
【24h】

Finasteride: an update of its use in the management of symptomatic benign prostatic hyperplasia.

机译:非那雄胺:一种在症状性良性前列腺增生症治疗中的更新。

获取原文
获取原文并翻译 | 示例
   

获取外文期刊封面封底 >>

       

摘要

Finasteride inhibits type 25alpha-reductase activity, significantly reducing dihydrotestosterone levels. Consequent reductions in prostate volume, increases in urinary flow rates and improvements in symptoms compared with placebo have been observed in trials of up to 4 years' duration and in noncomparative extensions (for up to 6 years). Results from the 4-year placebo-controlled PLESS trial show finasteride to significantly reduce the risk of benign prostatic hypertrophy (BPH)-related acute urinary retention and the requirement for surgical intervention. Finasteride has significantly greater efficacy in patients with a large prostate (> or = 40 ml) than in patients with a small prostate. However, the predictive value of prostate size has been questioned. Results of an earlier comparative 1-year trial show terazosin monotherapy and terazosin plus finasteride therapy to be significantly more effective than both finasteride monotherapy and placebo in reducing symptom scores and improving maximum urinary flow rates. Prostatic volume was significantly reduced by finasteride monotherapy and combination therapy only. The overall efficacy of finasteride in patients with mild to moderate symptomatic BPH tended to be greater than that of serenoa repens (Permixon) in a 6-month trial. A US cost analysis model indicates that finasteride and terazosin are less expensive than transurethral resection of the prostate (TURP) during the first 2 years of initiation. Canadian cost-effectiveness and cost-utility analyses using decision analysis modelling have shown primary intervention with finasteride to provide more quality-adjusted life years (QALYs) at lesser cost than watchful waiting or TURP in patients with moderate symptoms who receive the drug for < or = 3 years and < or = 14 years, respectively, but fewer QALYs at a higher cost in patients with severe symptoms needing therapy for > or = 4 years. Confirmatory prospective economic studies are required. Finasteride appears to improve overall quality of life to a similar extent to serenoa repens; patient satisfaction appears similar with finasteride and TURP. Finasteride is generally well tolerated. Most commonly reported adverse effects are sexually related (1 to 2.1 %). Gynaecomastia has been reported in 0.4% of patients. CONCLUSIONS: Despite modest improvements in maximum urinary flow rates and symptom scores, finasteride is a first-line treatment option in those with moderate uncomplicated BPH, especially in patients with a large prostate (> or = 40 ml). It is also an option in patients with more severe symptoms who are unable or unwilling to undergo surgery and in those awaiting surgery. Importantly, finasteride appears to reduce disease progression, significantly decreasing the incidence of acute urinary retention and the requirement for surgical intervention; to date, no other pharmacological agent has been shown to reduce these outcomes.
机译:非那雄胺抑制25α型还原酶活性,从而显着降低二氢睾丸激素水平。与安慰剂相比,在长达4年的研究和非比较性延长研究(长达6年)中,前列腺体积随之减少,尿流率增加,症状改善。这项为期4年的安慰剂对照PLESS试验的结果显示,非那雄胺可显着降低良性前列腺肥大(BPH)相关的急性尿retention留的风险,并减少手术干预的需要。非那雄胺在前列腺大的患者(>或= 40 ml)中比在前列腺小的患者中具有显着更大的疗效。但是,前列腺大小的预测价值受到质疑。一项较早的比较期1年试验的结果显示,特拉唑嗪单一疗法和特拉唑嗪加非那雄胺疗法在降低症状评分和改善最大尿流率方面比非那雄胺单一疗法和安慰剂明显更有效。仅非那雄胺单药和联合疗法可显着降低前列腺体积。在为期6个月的试验中,非那雄胺在轻度至中度症状性BPH患者中的总体疗效倾向于比黑斑狼疮(Permixon)更好。美国的成本分析模型表明,在开始的头2年中,非那雄胺和特拉唑嗪的价格比经尿道前列腺切除术(TURP)便宜。使用决策分析模型进行的加拿大成本效益和成本效用分析表明,对于中度症状接受或接受药物治疗的中度症状患者,非那雄胺的主要干预措施能够以比等待观察或TURP更低的成本提供更多的质量调整生命年(QALY)。 =分别为3年和<或= 14年,但是对于严重症状需要治疗>或= 4年的患者,QALY较少,费用较高。需要进行验证性的前瞻性经济研究。非那雄胺似乎可以改善总体生活质量,其程度与Serenoa repens类似。患者的满意度与非那雄胺和TURP相似。非那雄胺通常被很好地耐受。最常见的不良反应是与性相关的(1-2.1%)。据报道有0.4%的患者患有妇科发育不全。结论:尽管最大尿流率和症状评分有所改善,但非那雄胺是中度单纯性BPH患者的一线治疗选择,尤其是对于前列腺较大(>或= 40 ml)的患者。对于无法或不愿接受手术的症状更严重的患者以及正在等待手术的患者,这也是一种选择。重要的是,非那雄胺似乎可以减少疾病进展,显着降低急性尿retention留的发生率和手术干预的需求;迄今为止,还没有其他药物可以降低这些预后。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱:kefu@zhangqiaokeyan.com

京公网安备:11010802029741号 ICP备案号:京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有
  • 客服微信

  • 服务号