'Duodart combo therapy improves adherence and long-term outcomes in BPH'

As personalized medicine grows in importance, interest is rising in combination therapies for benign prostatic hyperplasia (BPH) that improve adherence, relieve symptoms, and slow disease progression.

On Monday, GSK Korea hosted the “DUAL Symposium” at the Grand InterContinental Parnas in Seoul, bringing experts together to focus on Duodart, a BPH treatment that combines dutasteride and tamsulosin in a single capsule.

At the symposium, Professor Marcio A. Averbeck, neuro-urology coordinator at Moinhos de Vento Hospital in Brazil, and Professor Oh Cheol-young from Hallym University Sacred Heart Hospital presented the latest insights on BPH treatment and discussed effective strategies using real clinical cases.

Professor Averbeck highlighted that the EPICS (Enlarged Prostate International Comparator Study) found that dutasteride, the main component of Duodart, inhibits both 5-alpha-reductase type 1 and type 2. He clarified that, according to the study, sexual function–related side effects between dutasteride and finasteride were not significantly different.

Professor Marcio A. Averbeck highlighted the effectiveness of Duodart combination therapy at the Monday symposium. (Courtesy of GSK Korea)

Averbeck pointed out that the use of dutasteride-based therapy led to increased maximum urinary flow rate (Qmax) and reduced prostate size. He noted that these effects significantly lowered cases of acute urinary retention (AUR) and the need for BPH-related surgeries, as shown in study data.

He shared the CombAT (Combination of Avodart and Tamsulosin) study results, stating that patients receiving combination therapy over four years had a 65.8 percent lower risk of acute urinary retention or BPH-related surgery compared to those on tamsulosin alone.

“These results demonstrate that the combination therapy of dutasteride and tamsulosin is a treatment option that can effectively control disease progression in the long term, not just provide short-term symptom relief,” Professor Averbeck said.

He referenced the CONDUCT study, which directly compared starting Duodart immediately with watchful waiting in treatment-naive patients with moderate BPH. The study found that immediate Duodart use reduced the risk of BPH progression by 43.1 percent compared to watchful waiting, with notable symptom improvement appearing as early as one month after treatment and lasting up to 24 months.

“Delaying treatment can reduce the effectiveness of symptom improvement and increase the risk of long-term complications. It is important to initiate appropriate combination therapy considering the patient's condition,” Professor Averbeck advised.

Following Professor Averbeck's presentation, Professor Oh outlined BPH treatment strategies based on hypothetical patient profiles. He presented cases involving patients with various underlying conditions and medication adherence challenges and suggested tailored treatment approaches for each scenario.

Oh noted that a network meta-analysis comparing tamsulosin with other alpha-blockers rated tamsulosin highly for its ability to improve BPH symptoms. He clarified that tamsulosin 0.4 mg significantly raised maximum urinary flow rate compared to 0.2 mg and was more effective for lower urinary tract symptoms. Regarding sexual function, he explained there was no significant difference in sexual side effects between Duodart and finasteride.

The lecture featured multiple patient cases, such as those taking several medications and elderly patients with chronic diseases. Emphasis was placed on how Duodart’s combination formulation enhances medication adherence while also providing symptom relief and delaying disease progression. The discussion highlighted that, particularly for elderly patients, symptom improvement can alleviate discomfort—such as reduced sleep quality from nocturia—thereby contributing to better quality of life.

“Treatment for BPH requires a personalized approach that comprehensively considers each patient's individual characteristics, including existing medications. It is crucial to assess the patient's overall condition rather than simply prescribing based on symptoms alone,” Professor Oh said.

Among global guidelines, the European Association of Urology (EAU) recommends combination therapy with 5α-reductase inhibitors and alpha-blockers for moderate-to-severe BPH patients at high risk of disease progression. The American Urological Association (AUA) recommends this combination therapy as a treatment option to delay BPH progression and reduce the risk of urinary retention and future prostate-related surgery.