Doxazosin versus tamsulosin for the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) - systematic literature review and network meta-analysis

Sep 30, 2026

Doxazosin and tamsulosin are widely used α1-blockers for male lower urinary tract symptoms associated with benign prostatic hyperplasia. Guidelines suggest comparable efficacy among α1-blockers, with tolerability varying by dose and formulation. This systematic review and Bayesian network meta-analysis compared multiple doxazosin and tamsulosin dose regimens, assessing International Prostate Symptom Score domains, quality of life, overall adverse events, and discontinuation using RCT evidence through December 2024.

LanguageEnglish

CategoryHealthcare

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Reading Time40 min

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Abstract

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Methods

Results

Conclusions

Introduction

World Journal of Urology (2026) 44:78 [https://doi.org/10.1007/s00345-025-06122-1](https://doi.org/10.1007/s00345-025-06122-1) REVIEW Doxazosin versus tamsulosin for the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/ BPH): systematic literature review and network meta-analysis Matthias Oelke1,2 · Jean-Nicolas Cornu3 · Ishveen Chopra4 · Thomas R. W. Herrmann2,5,6 · Tarek Hassan7 Received: 26 March 2025 / Accepted: 25 November 2025 © The Author(s) 2026 Abstract Purpose Doxazosin and tamsulosin are the most frequently used α 1-blockers for the treatment of male lower urinary tract symptoms. Clinical practice guidelines state that all α 1-blockers have a similar clinical efficacy but differ in tolerability when used in appropriate doses. We compared the efficacy and tolerability of different doses/formulations of doxazosin (immediate release 2, 4 or 8mg; gastrointestinal therapeutic system [GITS] 4 or 8mg) versus tamsulosin (modified release 0.2, 0.4 or 0.8mg; oral controlled absorption system [OCAS] 0.4mg) . Methods PubMed, EMBASE and Cochrane databases were systematically searched until December 2024 to identify RCTs with doxazosin and/or tamsulosin. Bayesian random-effects models estimated efficacy and tolerability outcomes, including all International Prostate Symptom Score (IPSS) variations, QoL, overall adverse events (AE) and discontinuation. Tests for heterogeneity, similarity, and consistency ensured robust estimates. Results In total, 1,866 abstracts were identified, of which we included 40 publications with 12,201 participants. Doxazosin GITS 4mg had the largest mean (95% credible interval) improvement from baseline in total IPSS (-10.07 [-11.96, -8.25]), IPSS-QoL (-1.82 [-2.07, -1.60]) and IPSS storage-subscore (-4.26 [-4.29, -3.40]), and was statistically superior compared to most tamsulosin doses. No significant differences between different doses or formulations for the two drugs were seen for the IPSS voiding-subscore, maximum urine flow or post-void residuals. Only doxazosin GITS 4mg had significantly lower odds of discontinuation due toAE compared to tamsulosin OCAS 0.4mg. Conclusions This network meta-analysis found a statistically significantly greater clinical efficacy (IPSS-T, IPSS-S, QoL improvement) for doxazosin GITS 4mg versus most tamsulosin formulations and a similar overall tolerability profile. Keywords Adrenergic alpha blockers · Benign prostatic hyperplasia · Doxazosin · Lower urinary tract symptoms · Network meta-analysis · Tamsulosin 􀀍 1 2 3 Matthias Oelke [matthias.oelke@stgag.ch](matthias.oelke@stgag.ch) Interdisciplinary Pelvic Floor Center, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld and Münsterlingen, Pfaffenholzstr. 4, 8500 Frauenfeld, Switzerland Hannover Medical School, Hannover, Germany Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France 4 Pharmerit International, Bethesda, MD, USA 5 Department of Urology, Spital Thurgau AG, Frauenfeld and Münsterlingen, Frauenfeld, Switzerland 6 Division of Urology, Department of Surgical Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa 7 Viatris Inc., New York, NY, USA 1 3 Introduction Benign prostatic hyperplasia (BPH) is a histologic observation characterized by the proliferation of epithelial and/or stromal cells, which may lead to benign prostatic enlargement. The incidence of BPH significantly increases with age: approximately 50% of men aged 50–60 years, 70–80% of men aged 61–80 years, and 90% of men aged > 80 years are affected [1–5] . Currently, there is an alarming rise in the disease burden globally with 94 million patients diagnosed with BPH [6] . Over the past 3 decades, the global prevalence, incidence, and disability-adjusted life years of BPH have increased by 119–121%[7]. Lower urinary tract symptoms associated with BPH (LUTS/BPH) is a clinical diagnosis based on symp

FAQs

What is the primary objective of the study?

To compare the efficacy and tolerability of different doses and formulations of doxazosin versus tamsulosin for male LUTS/BPH using a systematic literature review and network meta-analysis.

How were the trials identified and analyzed?

PubMed, EMBASE, and Cochrane databases were searched until December 2024 to identify RCTs. Bayesian random-effects models estimated efficacy and tolerability outcomes, including IPSS variants, QoL, adverse events, and discontinuation.

Which regimen showed the strongest efficacy results?

Doxazosin gastrointestinal therapeutic system (GITS) 4 mg produced the largest mean improvement from baseline in total IPSS, IPSS-QoL, and IPSS storage sub-score, outperforming most tamsulosin doses.

What did the study find about discontinuation due to adverse events?

Only doxazosin GITS 4 mg showed significantly lower odds of discontinuation due to adverse events compared with tamsulosin OCAS 0.4 mg.

Sep 30, 2026

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