Effect of Alfuzosin on Quality of Life
BPH is a disease of symptoms. Patients with moderate to severe BPH symptoms often change their daily activities to accommodate their voiding patterns. In one study, more than 15% of men who were at least 60 years of age reported that they needed to limit fluid intake before bedtime or long car rides. Also, such patients often needed to interrupt their daily activities because of frequent bathroom breaks. Although many patients can adjust to changes in their daily activities, others cannot, and their quality of life (QOL) decreases. Therefore, it is important to administer QOL assessments to patients with BPH. The World Health Organization and Agency for Health Care Policy and Research recommend using QOL assessments to nically measure a patient's perception of impaired function in performing daily activities when assessing disease severity and treatment efficacy.
QOL assessments are questionnaires that patients can self-administer. Many different QOL questionnaires are used,[60,61,62,63] and there is no agreement as to the best tool to use. QOL assessment tools for men with BPH vary with indices measured and scoring systems, making it somewhat confusing to analyze the literature in this area. Some include questions about a patient's perception of his sexual performance. Sexuality is closely linked to QOL for men, yet this variable is difficult to measure. Independent of drug therapy, BPH may negatively affect a patient's perception of sexual function, which in turn affects his overall evaluation of drug therapy.
Studies assessing QOL are not randomized, controlled clinical trials. Instead, prospective, nonexperimental, open-label, longitudinal, uncontrolled study designs are used to ensure a large enough patient sample to be representative of the typical patients receiving treatment for BPH. Often, the efficacy of the drug in these studies needs to be compared to historical controls. Because the patient dropout rate tends to be higha 10% rate is commonit is somewhat difficult to evaluate results from these studies.[64,65]
Nevertheless, such studies generally show that an improvement in QOL can be measured one to three months after alfuzosin treatment has begun. Thereafter, QOL assessments for BPH patients show continuous improvement over 12 months. Interestingly, objective values for peak urinary flow rate stabilize after three months. Patients with worse symptoms at baseline often show the greatest improvements in QOL. Older patients have less of an improvement in QOL when sexual function is self-evaluated, perhaps because older men are less likely to be sexually active in general. ER and IR alfuzosin are comparable in improving QOL.[32,37,57,63,64,65,66,67] Five such studies are summarized in Table 4 .
Am J Health Syst Pharm. 2003;60(14) © 2003 American Society of Health-System Pharmacists
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