Sridharan K et al, 2018: Efficacy and safety of alpha blockers in medical expulsive therapy for ureteral stones: a mixed treatment network meta-analysis and trial sequential analysis of randomized controlled clinical trials.
Sridharan K, Sivaramakrishnan G.
Associate Professor, Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama , Bahrain.
Assistant Professor in Prosthodontics, School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva , Fiji Islands.
Alpha blockers (AB) are the main group of drugs used for medical expulsive therapy (MET) in patients with ureteral stones. However, there is no consensus on the relative efficacy and safety of individual AB in MET. Areas covered: The present work is a network meta-analysis of randomized controlled trials comparing AB with either placebo or standard of care in patients with ureteral stones. Electronic databases of Medline, Cochrane CENTRAL and Google Scholar were searched for eligible clinical studies. Inverse variance heterogeneity model was used for mixed treatment comparisons. Stone expulsion rate (SER) and stone expulsion time (SET) were the primary outcomes. Sub-group analyses for the following sub-groups were carried out: children; after shockwave lithotripsy; stone size of ≤5 mm; >5 mm; proximal and distal ureteral stones. Expert review: AB, phosphodiesterase inhibitors and combined AB with corticosteroids were observed with significant stone expulsion rate compared to control group in a recent network meta-analysis. Due to lack of head-to-head clinical trials within AB, only tamsulosin has been widely recommended by various urological guidelines. The results of this network meta-analysis will guide the future researchers in evaluating other promising ABs as agents for MET.
Expert Rev Clin Pharmacol. 2018 Mar;11(3):291-307. doi: 10.1080/17512433.2018.1424537. Epub 2018 Jan 19. Review.
Here is a next-generation meta-analyses: network meta-analysis. In the discussion section the authors state: “More recently, Hollingsworth et al.  conducted direct pairwise meta-analysis of 55 randomized controlled trials comparing ABs in patients with ureteral stones. The findings of the present network meta-analysis corroborate with their findings.”
Do we really profit from more refined and sophisticate statistics or are these publications driven by third-party interest?
All drugs mentioned are off -label use; I guess that manufactures do not need and do not want to spend money for proper large scale studies because the drugs are used as long as we have studies to suggest that more studies are needed.
Among all effects evaluated the side effects were the most significant outcome differences compared to standard care.