Evidence is enough? A systematic review and network meta-analysis of the efficacy of tamsulosin 0.2 mg and tamsulosin 0.4 mg as an initial therapeutic dose in asian benign prostatic hyperplasia patients

Purpose: We compared the efficacy of tamsulosin between 0.2 mg and 0.4 mg in Asian prostatic hyperplasia (BPH) patient using network meta-analysis due to lack of studies with direct comparison. Methods: The literature search was conducted using the MEDLINE, Embase, and Cochrane Library. Keywords used wer "BPH," "tamsulosin," "placebo." Experimental groups were defined as tamsulosin 0.2 mg (Tam 0.2) and 0.4 mg (Tam 0.4) and common control group was defined as placebo for indirect treatment comparison. Mixed treatment comparison was performed including one direct comparison study. Results: Seven studies met the eligible criteria. Indirect treatment comparison revealed that total International Prostate Symptom Score (IPSS) and quality of life score of IPSS were not significantly different in Tam 0.2 and Tam 0.4 (P > 0.05). There was no sig nificant difference of maximal flow rate and postvoid residual urine volume in Tam 0.2 and Tam 0.4 (P > 0.05). Mixed treatmen comparison including one direct comparison study showed inconsistency (P < 0.001). Therefore, analysis using direct treatmen comparison effect sizes of Tam 0.2 vs. placebo and Tam 0.4 vs. placebo was done and there was no significant difference. Conclusions: Network meta-analysis showed no difference of efficacy between tamsulosin 0.2 mg and 0.4 mg and the evi dence of tamsulosin 0.4 mg as initial dose for Asian BPH patient seems to be insufficient. Therefore, initial dose of tamsulosin for Asian BPH patient should be 0.2 mg.