Risk of Dementia in Patients with Benign Prostatic Hyperplasia: A Meta-analysis Comparing Tamsulosin with PGK1 Agonists, 5-ARI, and Other α-Blockers
Alice Rayane Ferreira da Silva1, Rafael Aguiar1, Gabriel Araújo2, Antônia Campelo2, Lucas Linhares2, Layla Benevides2, Luis Rego2, Bianca Pinheiro2, Samuel Pinheiro3, Pedro Carvalho4, Artur Menegaz de Almeida5
1Federal University of Piaui, 2State University of Piaui, 3Federal University of Bahia, 4Federal University of Amazonas, 5Federal University of Mato Grosso
Objective:
This meta-analysis aims to compare the risk of dementia in patients with benign prostatic hyperplasia (BPH) treated with tamsulosin or 5-α reductase inhibitors (5ARI), prostaglandin K1 receptor agonists (PGK1a), and other α-1 blockers.
Background:
Benign prostatic hyperplasia (BPH) is commonly treated with tamsulosin, an α1-adrenoceptor antagonist. However, recent studies have suggested that tamsulosin may increase the risk of dementia, while other interventions, including PGK1 agonists, have been associated with a protective factor for dementia.
Design/Methods:
PubMed, Scopus and Web of Science databases were systematically searched until August 2024, for observational studies assessing the dementia risk in patients using 5ARI, PGK1 agonists, and α-1 blockers, including tamsulosin, for BPH. Hazard ratios (HR) were analyzed with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics. RStudio version 4.3.2 was used for statistical analysis.
Results:
A total of 3 observational studies including 1,280,008 patients were analyzed, of which 76,3% were diagnosed with dementia, and 23,7% were diagnosed with dementia with Lewy bodies (DLB) after treatment with 5ARI, PGK1 agonists or α-1 blockers for BPH. For DLB patients, there was a significant reduction in the risk of developing dementia with Lewy bodies for patients treated with tamsulosin, compared with 5ARI and PGK1 agonists (HR 0.63; 95% CI 0.53–0.76; P < 0.001; I² = 58%). In contrast, for general dementia, the treatment with tamsulosin resulted in a significantly increased risk, compared with 5ARI and other α-1 blockers (HR 1.13; 95% CI 1.03–1.23; P = 0.005; I² = 82%). In the general analysis, a statistically significant risk of dementia was not reached.
Conclusions:
In this meta-analysis, consistent results suggest that tamsulosin reduces the risk of DLB but increases the risk of general dementia compared to other therapies for benign prostatic hyperplasia.
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