Tamsulosin and placebo vs tamsulosin and tadalafil in male lower urinary tract symptoms: a double‐blinded, randomised controlled trial
Santhosh Nagasubramanian, Nirmal Thampi John, Belavendra Antonisamy, Rajiv Paul Mukha, Chandra Singh Jeyachandra Berry, Santosh Kumar, Antony Devasia, Nitin Kekre
Abstract
Objective To compare the efficacy and safety of tamsulosin vs the combination of tamsulosin and tadalafil in male lower urinary tract symptoms (LUTS). Patients and Methods This was a double‐blinded, parallel‐arm randomised controlled trial. Men aged >45 years with moderate LUTS and a maximum urinary flow rate (Q max ) of 5–15 mL/s were included. One arm received 0.4 mg tamsulosin only (Group‐A), while the second received 5 mg tadalafil with tamsulosin (Group‐B). The primary outcome was the International Prostate Symptom Score (IPSS). Secondary outcomes were IPSS quality of life (QoL) score, five‐item version of the International Index of Erectile Function (IIEF‐5) score, Q max , and post‐void residual urine (PVR). Block randomisation was used. Placebo was used for blinding and allocation concealment. Intention‐to‐treat analysis was used for outcome measures. Results Of the 183 men screened, 140 were randomised (71 in Group‐A, 69 in Group‐B); 116 (82.85%) (61 in Group‐A, 55 in Group‐B) completed the study. Baseline characteristics were comparable. The improvements in the IPSS, IPSS QoL score, IIEF score and Q max were −1.69 (95% confidence interval [CI] −1.4 to −2.0), −0.70 (95% CI −0.60 to −0.80), 3.8 (95% CI 3.4–4.2) and 1.8 mL/s (95% CI 1.1–2.4) respectively, in favour of the combination group. The difference in PVR was not significant. There were no serious adverse events (AEs). The dropout rate due to AEs was 2.85%. Myalgia (five patients) was the commonest AE in the combination group. Conclusion The combination of tamsulosin and tadalafil produced significantly better improvements in LUTS, QoL, erectile function and Q max compared to monotherapy with tamsulosin, without an increase in AEs.