前立腺肥大症に対するナフトピジルと塩酸タムスロシンの臨床効果の比較検討 - 先行薬剤無効例に対する他剤への切り替え効果 -

Abstract

前立腺肥大症に対する薬物療法としてα1-ブロッカーであるナフトピジル(244名)または塩酸タムスロシン(289名)による治療を行い, QOLスコアが改善しなかった症例に他方の薬剤を投与することにより2剤の臨床効果の違いを比較検討した.検討により最大尿流率や国際前立腺症状スコア(I-PSS)の総スコアが改善してもQOLスコア改善が認められない症例があることが明らかになった.また, ナフトピジルは塩酸タムスロシン無効例の残尿感, 間欠的排尿, 夜間頻尿を改善し, 塩酸タムスロシンはナフトピジル無効例の尿意切迫感, 尿勢の低下, 腹圧排水を改善することが示され, 治療効果がそれぞれの薬剤で異なることが示唆された

We compared the efficacy of naftopidil with that of tamsulosin hydrochloride for benign prostatic hyperplasia patients. Eighty-five patients without improvement of quality of life (QOL) score by the administration of 50-75 mg naftopidil for more than four weeks were assigned to receive doses of 0.1-0.2 mg tamsulosin hydrochloride and 89 patients without improvement of QOL score by the administration of 0.1-0.2 mg tamsulosin hydrochloride for more than four weeks were assigned to receive doses of 50-75 mg naftopidil once a day for 8 weeks. International prostate symptom score, maximum flow rate, residual urine volume and side effect profile were determined before the administration of the first medicine, before the administration of the second medicine and after 8 weeks of treatment with the second medicine. In the group without improvement of QOL score by naftopidil, significant improvements in symptoms of urgency, weak stream and straining were observed after 8 weeks of treatment with tamsulosin hydrochloride. In the group without improvement of QOL score by tamsulosin hydrochloride, significant improvements in symptoms of incomplete emptying, intermittency and nocturia were observed after 8 weeks of treatment with naftopidil. In conclusion, improvement of symptoms by each alpha 1-blocker differs symptom by symptom. Tamsulosin hydrochloride was superior to naftopidil for the symptoms of urine flow and naftopidil was superior to tamsulosin hydrochloride for the symptom of nocturia.