- Title
- Management of chronic prostatitis/ chronic pelvic pain syndrome: a systematic review and network meta-analysis
- Creator
- Anothaisintawee, Thunyarat; Attia, John; Nickel, J. Curtis; Thammakraisorn, Sangsuree; Numthavaj, Pawin; McEvoy, Mark; Thakkinstian, Ammarin
- Relation
- JAMA: The Journal of the American Medical Association Vol. 305, Issue 1, p. 78-86
- Publisher Link
- http://dx.doi.org/10.1001/jama.2010.1913
- Publisher
- American Medical Association
- Resource Type
- journal article
- Date
- 2011
- Description
- Context: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is common, but trial evidence is conflicting and therapeutic options are controversial. Objective: To conduct a systematic review and network meta-analysis comparing mean symptom scores and treatment response among α-blockers, antibiotics, anti-inflammatory drugs, other active drugs (phytotherapy, glycosaminoglycans, finasteride, and neuromodulators), and placebo. Data Sources: We searched MEDLINE from 1949 and EMBASE from 1974 to November 16, 2010, using the PubMed and Ovid search engines. Study Selection: Randomized controlled trials comparing drug treatments in CP/CPPS patients. Data Extraction: Two Reviewers independently extracted mean symptom scores, quality-of-life measures, and response to treatment between treatment groups. Standardized mean difference and random-effects methods were applied for pooling continuous and dichotomous outcomes, respectively. A longitudinal mixed regression model was used for network meta-analysis to indirectly compare treatment effects. Data Synthesis: Twenty-three of 262 studies identified were eligible. Compared with placebo, α-blockers were associated with significant improvement in symptoms with standardized mean differences in total symptom, pain, voiding, and quality-of-life scores of −1.7 (95% confidence interval [CI], −2.8 to −0.6), −1.1 (95% CI, −1.8 to −0.3), −1.4 (95% CI, −2.3 to −0.5), and −1.0 (95% CI, −1.8 to −0.2), respectively. Patients receiving α-blockers or anti-inflammatory medications had a higher chance of favorable response compared with placebo, with pooled RRs of 1.6 (95% CI, 1.1-2.3) and 1.8 (95% CI, 1.2-2.6), respectively. Contour-enhanced funnel plots suggested the presence of publication bias for smaller studies of α-blocker therapies. The network meta-analysis suggested benefits of antibiotics in decreasing total symptom scores (−9.8; 95% CI, −15.1 to −4.6), pain scores (−4.4; 95% CI, −7.0 to −1.9), voiding scores (−2.8; 95% CI, −4.1 to −1.6), and quality-of-life scores (−1.9; 95% CI, −3.6 to −0.2) compared with placebo. Combining α-blockers and antibiotics yielded the greatest benefits compared with placebo, with corresponding decreases of −13.8 (95% CI, −17.5 to -10.2) for total symptom scores, −5.7 (95% CI, −7.8 to −3.6) for pain scores, −3.7 (95% CI, −5.2 to −2.1) for voiding, and −2.8 (95% CI, −4.7 to −0.9) for quality-of-life scores. Conclusions: α-Blockers, antibiotics, and combinations of these therapies appear to achieve the greatest improvement in clinical symptom scores compared with placebo. Anti-inflammatory therapies have a lesser but measurable benefit on selected outcomes. However, beneficial effects of α-blockers may be overestimated because of publication bias.
- Subject
- chronic prostatitis; pelvic pain; α-blockers; antibiotics; anti-inflammatory drugs
- Identifier
- http://hdl.handle.net/1959.13/1066587
- Identifier
- uon:18172
- Identifier
- ISSN:0098-7484
- Language
- eng
- Reviewed
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