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. 2015 Sep;44(5):745-55.
doi: 10.1093/ageing/afv077. Epub 2015 Jun 23.

Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: results of a systematic literature review and international consensus validation process (LUTS-FORTA 2014)

Matthias Oelke  1 , Klaus Becher  2 , David Castro-Diaz  3 , Emmanuel Chartier-Kastler  4 , Mike Kirby  5 , Adrian Wagg  6 , Martin Wehling  7
Affiliations

Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: results of a systematic literature review and international consensus validation process (LUTS-FORTA 2014)

Matthias Oelke et al. Age Ageing. 2015 Sep.

Abstract

Aim: we aimed to systematically review drugs to treat lower urinary tract symptoms (LUTS) regularly used in older persons to classify appropriate and inappropriate drugs based on efficacy, safety and tolerability by using the Fit fOR The Aged (FORTA) classification.

Methods: to evaluate the efficacy, safety and tolerability of drugs used for treatment of LUTS in older persons, a systematic review was performed. Papers on clinical trials and summaries of individual product characteristics were analysed regarding efficacy and safety in older persons (≥65 years). The most frequently used drugs were selected based on current prescription data. An interdisciplinary international expert panel assessed the drugs in a Delphi process.

Results: for the 16 drugs included here, a total of 896 citations were identified; of those, only 25 reported clinical trials with explicit data on, or solely performed in older people, underlining the lack of evidence in older people for drug treatment of LUTS. No drug was rated at the FORTA-A-level (indispensable). Only three were assigned to FORTA B (beneficial): dutasteride, fesoterodine and finasteride. The majority was rated FORTA C (questionable): darifenacin, mirabegron, extended release oxybutynin, silodosin, solifenacin, tadalafil, tamsulosin, tolterodine and trospium. FORTA D (avoid) was assigned to alfuzosin, doxazosin, immediate release oxybutynin, propiverine and terazosin.

Conclusions: dutasteride, fesoterodine and finasteride were classified as beneficial in older persons or frail elderly people (FORTA B). For most drugs, in particular those from the group of α-blockers and antimuscarinics, use in this group seems questionable (FORTA C) or should be avoided (FORTA D).

Keywords: 5α-reductase inhibitors; adrenergic α blockers; adrenergic β-3 agonists; antimuscarinics; effectiveness; elderly; lower urinary tract symptoms; older people; phosphodiesterase 5 inhibitors; systematic review; tolerability.

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Figure 1.
Figure 1.
Flow diagram for the systematic review according to the PRISMA statement [s16].
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References

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