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Do Alpha-Blockers and 5-Alpha Reductase Inhibitors Increase Dementia Risk? A Network Meta-analysis.

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Summary

This study found no significant link between alpha-blockers or 5-alpha reductase inhibitors (5ARIs) and increased dementia risk in men with benign prostatic hyperplasia (BPH). Findings support informed prescribing for BPH medications.

Keywords:
5-Alpha reductase inhibitorsAlpha blockersBenign prostatic hyperplasiaDementia

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Area of Science:

  • Urology
  • Geriatric Medicine
  • Pharmacology

Background:

  • Benign prostatic hyperplasia (BPH) is commonly treated with alpha-blockers and 5-alpha reductase inhibitors (5ARIs).
  • Concerns exist regarding a potential association between these BPH medications and dementia risk.
  • Existing evidence on this association is inconsistent, necessitating further investigation.

Purpose of the Study:

  • To evaluate the potential association between alpha-blocker or 5ARI use and dementia risk in patients with BPH.
  • To provide clarity on medication safety for BPH management.

Main Methods:

  • Systematic literature search across 7 databases following PRISMA guidelines.
  • Risk of bias assessment using the ROBINS-I tool for included non-randomized studies.
  • Bayesian network meta-analysis to estimate risk ratios and ranking probabilities (SUCRA).

Main Results:

  • Analysis of 5 multicenter studies with 3,650,434 patients revealed no significant dementia risk increase with alpha-blockers or 5ARIs compared to no treatment.
  • Low risk of bias was observed across the included studies.
  • Surface Under the Cumulative Ranking (SUCRA) analysis indicated a potential trend of higher dementia risk probability for 5ARIs, followed by specific alpha-blockers.

Conclusions:

  • The study found no statistically significant association between alpha-blockers, 5ARIs, and increased dementia risk.
  • Results can aid clinicians in making informed prescribing decisions for BPH, especially in older men.
  • Further large-scale studies with longer follow-up are recommended to solidify evidence for all BPH medications.