α1-Blockers and 5α-Reductase Inhibitors Are the Most Recommended Drugs in Treating Benign Prostatic Hyperplasia: An Evidence-Based Evaluation of Clinical Practice Guidelines

Xiao-Feng Xu; Guo-Xiong Liu; Cong Zhu; Xi-Min Qiao; Shao-Fu Yu; Tong Deng; Ying-Hui Jin

doi:10.3389/fphar.2020.00311

α1-Blockers and 5α-Reductase Inhibitors Are the Most Recommended Drugs in Treating Benign Prostatic Hyperplasia: An Evidence-Based Evaluation of Clinical Practice Guidelines

Front Pharmacol. 2020 Mar 25:11:311. doi: 10.3389/fphar.2020.00311. eCollection 2020.

Authors

Xiao-Feng Xu¹, Guo-Xiong Liu¹, Cong Zhu^{2

3}, Xi-Min Qiao¹, Shao-Fu Yu^{2

4}, Tong Deng^{2

3

5}, Ying-Hui Jin²

Affiliations

¹ Department of Urology, Xianyang Central Hospital, Xianyang, China.
² Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
³ Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.
⁴ Department of Pharmacy, The Huaihua Second People's Hospital, Huaihua, China.
⁵ Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China.

Abstract

Objective: To systematically evaluate the quality of clinical practice guidelines (CPG) for medically treating benign prostatic hyperplasia (BPH), and to compare the context of recommendations in order to provide references for clinical application.

Methods: We searched databases of National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and World Health Organization (WHO), PubMed, Embase, CNKI, VIP, WanFang Data, CBM, and Medlive from their establishment to October 13, 2019, to collect evidence-based guidelines and/or consensus on BPH. Method quality of included guidelines was assessed according to the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, and differences and similarities among recommendations were compared.

Results: A total of 22 guidelines were included, of which eight were updated versions. According to the AGREE II instrument, the median score of scope and purpose, stakeholder involvement, rigor of formulate, clarity of presentation, applicability, and editorial independence was 71.5%, 41%, 25%, 64%, 18%, and 28%, respectively. Based on recommendations for medical treatment, almost all guidelines recommended α1-blockers and 5α-reductase inhibitors, and most guidelines also recommended muscarinic receptor antagonists. In terms of drug combination therapy, most guidelines recommended "α1 blockers and 5α-reductase inhibitors", and some guidelines also recommended "α1 blockers and muscarinic receptor antagonists".

Conclusion: The recommendations from different guidelines were basically similar, only showing conflicts in some areas. The quality of included guidelines remains to be unified, and their context can provide valuable implications for development or improvement.

Keywords: AGREE II instrument; benign prostatic hyperplasia; clinical practice guideline; evidence-based evaluation; medical treatment.