Efficacy of α-blocker or 5α-reductase inhibitor withdrawal to continued combination therapy in the management of LUTS with BPH

According to a recent study, in men with benign prostatic hyperplasia (BPH)/ lower urinary tract symptoms (LUTS) who are unwilling to continue combination therapy, they may be presented with either α1-adrenergic receptor blocker (AB) or 5α-reductase inhibitor (5ARI) withdrawal if there is a minimum improvement of seven points in International Prostate Symptom Score-total (IPSS-T) and a reduction of at least 20% in prostate volume (PV). This research findings were published in the journal, The Prostate.

This randomized trial included 222 patients with BPH/LUTS who experienced a minimum seven-point improvement[S.1]  in IPSS-T and a ≥ 20% decrease in PV after commencing combination therapy. Patients were randomly assigned to continued-combination, AB-withdrawal, and 5ARI-withdrawal groups in a 1:1:1 ratio. Various parameters such as IPSS, EuroQol-five-dimensional questionnaire (EQ-5D-5L), overactive bladder symptom score, EuroQol-visual analog scale (EQ-VAS), PV, postvoid residual urine (PVR), maximal flow rate, and prostate-specific antigen level were assessed every 6 months over a 24-month period and the predictors of IPSS-T deterioration were evaluated.

At month 24, 27.8% of patients in the AB-withdrawal group and 26.4% in the 5ARI-withdrawal group experienced a deterioration of ≥2 points in IPSS-T. Among the patients, 5.6% and 5.7% necessitated the reintroduction of the previously withdrawn medication. EQ-VAS showed improvement in the continued combination group at month 24 compared to baseline (p = 0.028). The AB-withdrawal group displayed enhancements in EQ-VAS, EQ-5D-5L, and PVR at month 24 (all p < 0.005), while the 5ARI-withdrawal group demonstrated improvement in IPSS-S (p = 0.011). Diabetes was associated with a decrease in IPSS-T at the 24-month mark (p = 0.020)

Therefore, for men diagnosed with BPH experiencing LUTS who are unwilling to continue combination therapy may be offered the choice of either discontinuing AB or 5ARI treatment. This option is available if there is a minimum improvement of seven points in the IPSS-T and a reduction of at least 20% in PV.

Effect of low-dose colchicine in patients with type 2 diabetes and recent myocardial infarction

A recent study found that among patients with type 2 diabetes and a recent myocardial infarction, the daily intake of 0.5 mg of colchicine has been shown to greatly reduce the occurrence of cardiovascular events. This study’s findings were published in the journal, Diabetes care. 
The COLCOT study was a randomized, double-blind trial that included 959 patients with type 2 diabetes, and they were monitored for a median duration of 22.6 months. Patients were randomly assigned to receive either colchicine (n=462) at a daily dose of 0.5 mg or a placebo (n=497) initiated within 30 days of suffering a myocardial infarction. The primary endpoint of the study included composite of cardiovascular (CV) death, myocardial infarction, resuscitated cardiac arrest stroke, or urgent hospitalization for angina necessitating coronary revascularization.
The incidence of a primary end point event was 8.7% among patients in the colchicine group, whereas it was 13.1% in the placebo group (hazard ratio 0.65; 95% CI 0.44-0.96; P = 0.03). Nausea was reported in 2.7% and 0.8% in the study groups, while pneumonia occurred in 2.4% and 0.4% in the colchicine and placebo groups, respectively.
The above results demonstrate that in individuals diagnosed with type 2 diabetes (T2D) who have experienced a recent myocardial infarction, the administration of a daily dose of 0.5 mg colchicine results in a significant decrease in the occurrence of cardiovascular events.
 

Efficacy of dexamethasone on diabetic ketoacidosis complicated with acute pancreatitis

According to a recent study, dexamethasone has a good clinical effect on patients with diabetic ketoacidosis (DKA) complicated by acute pancreatitis (AP). The findings of this study were published in the journal, Medicine.

A randomized controlled trial included 106 DKA patients complicated with AP. Patients were randomized according to the random number table method to either a study group (n = 53) who were given dexamethasone and a placebo group (n = 53). The comparison between the two groups was based on changes in laboratory indexes and clinical symptoms prior to and as well as post-treatment adverse events.

Patients in the study group after treatment showed lower levels of random venous blood glucose, serum chlorine, serum sodium, urine glucose, urea nitrogen, urine ketone, serum amylase, and triglyceride, as well as higher levels of serum potassium and pH value compared to the placebo group. Study group patients demonstrated significant improvements in symptoms such as stomach pain, nausea, vomiting, diarrhea, polydipsia, polyuria, disorders of consciousness, and hypotension or shock. Additionally, the proportion of patients who experienced adverse reactions after treatment in the study group was significantly lower (17.0%) than in the control group (58.5%).

Based on the results of the study, it can be concluded that dexamethasone has a good clinical effect on patients with DKA complicated with AP.

Study Suggests α-Blocker or 5ARI Withdrawal May Be a Viable Option for Men with BPH/LUTS

A recent randomized trial has found that men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) may successfully withdraw from α-blocker (AB) or 5α-reductase inhibitor (5ARI) therapy after achieving symptom improvement.

The study, which included 222 men who showed significant improvements in their International Prostate Symptom Score (IPSS) and reduced prostate volume (PV) following combination therapy, compared the effects of continued combined treatment versus withdrawal of either AB or 5ARI.

At the 24-month follow-up, 27.8% of patients in the AB-withdrawal group and 26.4% in the 5ARI-withdrawal group reported slight symptom deterioration (IPSS-T increase of ≥2 points).

Despite this, very few patients (5.6% in the AB group and 5.7% in the 5ARI group) required readdition of the withdrawn drug. Notably, both withdrawal groups showed improvements in quality-of-life measures, including the EuroQol-visual analog scale (EQ-VAS), and reduced post-void residual urine.

The results indicate that, for men unwilling to maintain long-term combination therapy, withdrawal of either AB or 5ARI may be possible, provided they have showed considerable improvement in symptoms and prostate size. However, careful monitoring is essential, particularly for those with diabetes, which was associated with symptom deterioration.