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Sildenafil and Alfuzosin Combination Improves Both LUTS and Sexual Dysfunction. Presented at AUA

By Ed Susman

ATLANTA, G.A. -- May 29, 2006 -- The combination of sildenafil and alfuzosin appears to have synergistic effects in treating patients with both prostate problems and sexual dysfunction, researchers said here at the 101^st Annual Meeting of the American Urological Association (AUA).

"Treatment with the combination of drugs was safe and the most effective therapy to enhance both voiding and sexual function in men with lower urinary tract symptoms," said Steven Kaplan, MD, chief, Institute for Bladder and Prostate Health, Weill Medical College, Cornell University, New York, New York. "We have to move away from thinking about different compartments of the male pelvis as being independent from one another."

Dr. Kaplan discussed his study's findings during a press briefing on May 26^th.

Dr. Kaplan said the use of alfuzosin was aimed at relieving conditions in the prostate, while sildenafil (Viagra) was aimed at sexual dysfunction. In his study, 20 men were treated with alfuzosin for 12 weeks; 21 men received sildenafil, and another group of 21 received both drugs in combination.

All the patients on alfuzosin alone did well in treating prostate and bladder problems and had mild improvement of sexual functioning. Viagra alone showed a favorable but lesser impact on prostate problem and bladder compared with alfuzosin but, as expected, showed a major improvement in sexual functioning.

The group that was treated with the combination saw significant improvements in all parameters of bladder, prostate and sexual functioning measured.

Baseline mean International Prostate Symptom Scores (IPSS) for patients on alfuzosin 10 mg once a day was 17.8, and decreased to 14.8 after 12 weeks of therapy (P =.01). Patients on sildenafil 25 mg alone also experienced a reduction in mean IPSS score from 16.9 at baseline to 14.9 after 12 weeks (P =.03).

The group that received combination treatment had a decrease in mean IPSS score from 17.3 to 13.5, a decrease that reached significance at the P =.002 level, Dr. Kaplan said.

On the other hand, when patients with complaints of sexual dysfunction took alfuzosin, their mean scores on the International index of erectile function (IIEF) increased from 17.4 at baseline to 20.3 after 12 weeks (P =.11). Patients on sildenafil alone had an mean score increase from 14.3 to 21.4 (P =.01). The combination group had scores that increased from 16.2 at baseline to 25.7 at 12 weeks (P =.002).

AUA spokesperson and press briefing moderator Ira Sharlip, MD, clinical professor of urology, University of California, San Francisco, California, said the work presented indicates that we have more to learn about how the drugs -- especially the phosphodiesterase-5 inhibitors such as Viagra -- work in the body.

"Viagra only seems to works for about 5 to 6 hours for sexual functioning, yet it seemed to have 24-hour effects in patients with lower urinary tracks symptoms that relate to [voiding] frequency. Viagra also seemed to improve certain aspects of prostate health, but didn't improve urine flow that much," he said. Dr. Sharlip did not participate in the study.

Dr. Kaplan said large scale studies of the drugs need to be performed to better understand the true synergistic nature of the two drugs.


[Presentation title: Combination of an Alpha Blocker, Alfuzosin SR and a PDE-5 Inhibitor, Sildenafil Citrate is Superior to Monotherapy in Treating Lower Urinary Tract Symptoms and Sexual Dysfunction. Abstract 1638]

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