IPSIndian Journal of Pharmacology
Home  IPS  Feedback Subscribe Top cited articles Login 
Users Online : 1694 
Small font sizeDefault font sizeIncrease font size
Navigate Here
  Search
 
  
Resource Links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (304 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)

 
In This Article
   References

 Article Access Statistics
    Viewed576    
    Printed2    
    Emailed0    
    PDF Downloaded38    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
LETTER TO THE EDITOR
Year : 2020  |  Volume : 52  |  Issue : 6  |  Page : 524-525
 

Response to “A comparative study of alpha-1a blockers (tamsulosin) versus estrogens in the treatment of lower urinary tract symptoms in perimenopausal females”


Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, Maharashtra, India

Date of Submission12-Jul-2020
Date of Decision13-Jul-2020
Date of Acceptance04-Jan-2021
Date of Web Publication19-Feb-2021

Correspondence Address:
Dr. Anant Patil
Department of Pharmacology, Dr. DY Patil Medical College, Nerul, Navi Mumbai - 400 706, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijp.IJP_439_20

Rights and Permissions



How to cite this article:
Patil A. Response to “A comparative study of alpha-1a blockers (tamsulosin) versus estrogens in the treatment of lower urinary tract symptoms in perimenopausal females”. Indian J Pharmacol 2020;52:524-5

How to cite this URL:
Patil A. Response to “A comparative study of alpha-1a blockers (tamsulosin) versus estrogens in the treatment of lower urinary tract symptoms in perimenopausal females”. Indian J Pharmacol [serial online] 2020 [cited 2021 Aug 2];52:524-5. Available from: https://www.ijp-online.com/text.asp?2020/52/6/524/309730




Sir,

I read with interest the article “A comparative study of alpha-1a blockers (tamsulosin) versus estrogens in the treatment of lower urinary tract symptoms in perimenopausal females” published recently.[1] The study is unique from two aspects. First, references cited in the article, as well as literature search of MEDLINE database using PubMed till date, indicate that there are no head-to-head comparative trials between tamsulosin versus estrogen, and second, tamsulosin is currently used as off-label treatment of this indication. Considering this, the report has a potential for being used by clinicians as an important reference while selecting an option for the treatment of perimenopausal females as well as useful reference while developing guidelines for the treatment of specific patient population. In the study performed by Maiti et al.,[1] tamsulosin outperformed topical estrogen for efficacy in the treatment of lower urinary tract symptoms in the studied population.

Some studies have explored potential of using tamsulosin in the treatment of lower urinary tract symptoms in perimenopausal females. After carefully reading the article by Maiti et al.,[1] few important points related to methodology and results that caught attention are summarized below.

As assignment of the patient to a particular treatment could be a source of bias, blinding and randomization to two treatment groups might have helped to avoid this bias. Another important aspect in comparative trials is matching the patient groups for baseline characteristics. Classification of patients into different severity types (mild, moderate, or severe) can provide understanding about similarity or difference in the severity in the treatment groups at baseline.

Patients in one group received fixed dose, i.e., tamsulosin 0.4 mg once daily, whereas other group received topical estrogen therapy 0.5%–1% twice daily. Method of dose titration and information about number of patients receiving 1% twice daily treatment are also useful information. As tamsulosin As tamsulosin is used off-label in this indication, exact dose is unknown. Some studies have used tamsulosin 0.2 mg,[2],[3] whereas others[4] used same dose as in the study by Maiti et al.[1]

In the discussion section, authors have mentioned that topical estrogen offers advantage of lesser side effects. However, in this study, investigators did not report incidence of adverse events in two treatment groups. Although tamsulosin is generally well tolerated,[2] adverse effects are possible. A study evaluating 8-week treatment with tamsulosin 0.2 mg reported dizziness in three patients and some other adverse events were reported in five patients.[3] In this study, discontinuation rate in the tamsulosin group was 20% (eight out of 40 patients discontinued), whereas in the topical estrogen group, discontinuation rate was 15% (six out of 40 patients discontinued). Numerically, more patients discontinued in the tamsulosin group; statistical significance is unknown. Discontinuation could be because of loss to follow-up, lack of efficacy, safety reasons, or other causes. According to the results of systematic review, primary reasons for discontinuation of tamsulosin are adverse events or insufficient response.[5] The reasons for the discontinuation of patients in this study are not known. In such case, separate analysis of intention-to-treat population and per protocol population may provide better understanding of the results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Maiti K, Jaiswal A, Pal DK. A comparative study of alpha-1a blockers (tamsulosin) versus estrogens in the treatment of lower urinary tract symptoms in perimenopausal females. Indian J Pharmacol 2020;52:6-9.  Back to cited text no. 1
  [Full text]  
2.
Chang SJ, Chiang IN, Yu HJ. The effectiveness of tamsulosin in treating women with voiding difficulty. Int J Urol 2008;15:981-5.  Back to cited text no. 2
    
3.
Lee KS, Han DH, Lee YS, Choo MS, Yoo TK, Park HJ, et al. Efficacy and safety of tamsulosin for the treatment of non-neurogenic voiding dysfunction in females: A 8-week prospective study. J Korean Med Sci 2010;25:117-22.  Back to cited text no. 3
    
4.
Pischedda A, Pirozzi Farina F, Madonia M, Cimino S, Morgia G. Use of alpha1-blockers in female functional bladder neck obstruction. Urol Int 2005;74:256-61.  Back to cited text no. 4
    
5.
Kaplan SA, Chughtai BI. Safety of tamsulosin: A systematic review of randomized trials with a focus on women and children. Drug Saf 2018;41:835-42.  Back to cited text no. 5
    




 

Top
Print this article  Email this article
 

    

Site Map | Home | Contact Us | Feedback | Copyright and Disclaimer
Online since 20th July '04
Published by Wolters Kluwer - Medknow