nach oben

International Urology and Nephrology

Erschienen in:

10.02.2023 | Urology - Original Paper

Clinical outcomes of withdrawing one medication from long-term combination therapy comprising α-blocker and 5α-reductase inhibitor for benign prostatic hyperplasia

verfasst von: Jae Duck Choi, Tag Keun Yoo, Jung Yoon Kang, Hyuk-Dal Jung, Jun Ho Lee

Erschienen in: International Urology and Nephrology | Ausgabe 4/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To assess adherence to combination therapy comprising α-adrenergic blocker (AB) and 5α-reductase inhibitor (5ARI) for benign prostatic hyperplasia (BPH) in a real-world setting and whether lower urinary tract symptoms (LUTS) will relapse after discontinuing one medication from long-term combination therapy.

Methods

BPH/LUTS patients receiving initial AB +5ARI combination therapy for at least 1 year between January 2012 and January 2017 were retrospectively analyzed. The patients were classified into DC-AB group (n = 65, AB discontinued) and DC-5ARI group (n = 77, 5ARI discontinued) and followed up. Clinical effects were assessed at baseline and annually using the International Prostatic Symptoms Score (IPSS), quality of life (QoL) index, total prostate volume (TPV), maximal flow rate (Qmax), and prostate-specific antigen (PSA) level.

Results

Of total 1783 patients, 809 (45.4%) patients were identified with more than 1-year combination therapy. After withdrawal of one medication from combination therapy, the TPV progression (27.6% vs. − 10.8%; P < 0.001) and the requirement for prostate surgery (14.3% vs. 6.1%; P = 0.038) were significantly higher in the DC-5ARI group than in the DC-AB group. The rate of resuming combination therapy was significantly higher in the DC-5ARI group than in the DC-AB group (38.9% vs. 23.0%; P = 0.009).

Conclusions

Adherence to combination BPH therapy is relatively low. Although patients adhered to combination therapy for more than 1 year, a higher risk of requiring prostate surgery or resuming combination therapy was observed in patients who discontinued 5ARI.

Emberton M, Andriole GL, de la Rosette J, Djavan B, Hoefner K, Vela Navarrete R, Nordling J, Roehrborn C, Schulman C, Teillac P, Tubaro A, Nickel JC (2003) Benign prostatic hyperplasia: a progressive disease of aging men. Urology 61(2):267–273. https://doi.org/10.1016/s0090-4295(02)02371-3CrossRefPubMed

Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, Lieber MM (1997) Natural history of prostatism: risk factors for acute urinary retention. J Urol 158(2):481–487. https://doi.org/10.1016/s0022-5347(01)64508-7CrossRefPubMed

Marks LS, Andriole GL, Fitzpatrick JM, Schulman CC, Roehrborn CG (2006) The interpretation of serum prostate specific antigen in men receiving 5alpha-reductase inhibitors: a review and clinical recommendations. J Urol 176(3):868–874. https://doi.org/10.1016/j.juro.2006.04.024CrossRefPubMed

Madersbacher S, Marszalek M, Lackner J, Berger P, Schatzl G (2007) The long-term outcome of medical therapy for BPH. Eur Urol 51(6):1522–1533. https://doi.org/10.1016/j.eururo.2007.03.034CrossRefPubMed

Fourcade RO, Lacoin F, Rouprêt M, Slama A, Le Fur C, Michel E, Sitbon A, Cotté FE (2012) Outcomes and general health-related quality of life among patients medically treated in general daily practice for lower urinary tract symptoms due to benign prostatic hyperplasia. World J Urol 30(3):419–426. https://doi.org/10.1007/s00345-011-0756-2CrossRefPubMed

Strope SA, Elliott SP, Saigal CS, Smith A, Wilt TJ, Wei JT (2011) Urologist compliance with AUA best practice guidelines for benign prostatic hyperplasia in medicare population. Urology 78(1):3–9. https://doi.org/10.1016/j.urology.2010.12.087CrossRefPubMed

De Nunzio C, Tubaro A (2011) BPH: unmet needs in managing LUTS–a European perspective. Nat Rev Urol 9(1):9–10. https://doi.org/10.1038/nrurol.2011.190CrossRefPubMed

Becher E, Roehrborn CG, Siami P, Gagnier RP, Wilson TH, Montorsi F (2009) The effects of dutasteride, tamsulosin, and the combination on storage and voiding in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the Combination of Avodart and Tamsulosin study. Prostate Cancer Prostatic Dis 12(4):369–374. https://doi.org/10.1038/pcan.2009.37CrossRefPubMed

Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, Morrill BB, Gagnier RP, Montorsi F (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol 57(1):123–131. https://doi.org/10.1016/j.eururo.2009.09.035CrossRefPubMed

10.

Terris MK, Stamey TA (1991) Determination of prostate volume by transrectal ultrasound. J Urol 145(5):984–987. https://doi.org/10.1016/s0022-5347(17)38508-7CrossRefPubMed

11.

McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM Jr, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349(25):2387–2398. https://doi.org/10.1056/NEJMoă56CrossRefPubMed

12.

Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Morrill B, Montorsi F (2008) The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol 179(2):616–621. https://doi.org/10.1016/j.juro.2007.09.084. (discussion 621)CrossRefPubMed

13.

Lee JW, Kim JH (2022) Drug prescription patterns during initial treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia: a study based on health insurance review and assessment database. J Korean Med Sci 37(12):e95. https://doi.org/10.3346/jkms.2022.37.e95CrossRefPubMedPubMedCentral

14.

Gruschkus S, Poston S, Eaddy M, Chaudhari S (2012) Adherence to 5-alpha reductase inhibitor therapy for benign prostatic hyperplasia: clinical and economic outcomes. P t 37(8):464–470PubMedPubMedCentral

15.

Krueger KP, Berger BA, Felkey B (2005) Medication adherence and persistence: a comprehensive review. Adv Ther 22(4):313–356. https://doi.org/10.1007/bf02850081CrossRefPubMed

16.

Eisen C, Lulic Z, Palacios-Moreno JM, Adalig B, Hennig M, Cortes V, Gilg F, Kostev K (2020) Persistence and adherence to dutasteride/tamsulosin fixed-dose versus free-combination alpha blocker/5ARI therapy in patients with benign prostate hyperplasia in Germany. Int J Clin Pharmacol Ther 58(1):37–49. https://doi.org/10.5414/cp203549CrossRefPubMed

17.

Cindolo L, Pirozzi L, Fanizza C, Romero M, Tubaro A, Autorino R, De Nunzio C, Schips L (2015) Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study. Eur Urol 68(3):418–425. https://doi.org/10.1016/j.eururo.2014.11.006CrossRefPubMed

18.

Matsukawa Y, Takai S, Funahashi Y, Majima T, Kato M, Yamamoto T, Gotoh M (2017) Effects of withdrawing α1-blocker from combination therapy with α1-blocker and 5α-reductase inhibitor in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a prospective and comparative trial using urodynamics. J Urol 198(4):905–912. https://doi.org/10.1016/j.juro.2017.05.031CrossRefPubMed

19.

Kim HW, Moon DG, Kim HM, Hwang JH, Kim SC, Nam SG, Park JT (2011) Effect of shifting from combination therapy to monotherapy of α-blockers or 5α-reductase inhibitors on prostate volume and symptoms in patients with benign prostatic hyperplasia. Korean J Urol 52(10):681–686. https://doi.org/10.4111/kju.2011.52.10.681CrossRefPubMedPubMedCentral

20.

Lin VC, Liao CH, Kuo HC (2014) Progression of lower urinary tract symptoms after discontinuation of 1 medication from 2-year combined alpha-blocker and 5-alpha-reductase inhibitor therapy for benign prostatic hyperplasia in men–a randomized multicenter study. Urology 83(2):416–421. https://doi.org/10.1016/j.urology.2013.09.036CrossRefPubMed

21.

Kim W, Jung JH, Kang TW, Song JM, Chung HC (2014) Clinical effects of discontinuing 5-alpha reductase inhibitor in patients with benign prostatic hyperplasia. Korean J Urol 55(1):52–56. https://doi.org/10.4111/kju.2014.55.1.52CrossRefPubMedPubMedCentral

22.

Emberton M, Fitzpatrick JM, Rees J (2011) Risk stratification for benign prostatic hyperplasia (BPH) treatment. BJU Int 107(6):876–880. https://doi.org/10.1111/j.1464-410X.2010.10041.xCrossRefPubMed

Titel: Clinical outcomes of withdrawing one medication from long-term combination therapy comprising α-blocker and 5α-reductase inhibitor for benign prostatic hyperplasia
verfasst von: Jae Duck Choi
Tag Keun Yoo
Jung Yoon Kang
Hyuk-Dal Jung
Jun Ho Lee
Publikationsdatum: 10.02.2023
Verlag: Springer Netherlands
Erschienen in: International Urology and Nephrology / Ausgabe 4/2023
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-023-03476-6

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

„Jeder Fall von plötzlichem Tod muss obduziert werden!“

17.05.2024 Plötzlicher Herztod Nachrichten

Ein signifikanter Anteil der Fälle von plötzlichem Herztod ist genetisch bedingt. Um ihre Verwandten vor diesem Schicksal zu bewahren, sollten jüngere Personen, die plötzlich unerwartet versterben, ausnahmslos einer Autopsie unterzogen werden.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Schlechtere Vorhofflimmern-Prognose bei kleinem linken Ventrikel

17.05.2024 Vorhofflimmern Nachrichten

Nicht nur ein vergrößerter, sondern auch ein kleiner linker Ventrikel ist bei Vorhofflimmern mit einer erhöhten Komplikationsrate assoziiert. Der Zusammenhang besteht nach Daten aus China unabhängig von anderen Risikofaktoren.

Semaglutid bei Herzinsuffizienz: Wie erklärt sich die Wirksamkeit?

17.05.2024 Herzinsuffizienz Nachrichten

Bei adipösen Patienten mit Herzinsuffizienz des HFpEF-Phänotyps ist Semaglutid von symptomatischem Nutzen. Resultiert dieser Benefit allein aus der Gewichtsreduktion oder auch aus spezifischen Effekten auf die Herzinsuffizienz-Pathogenese? Eine neue Analyse gibt Aufschluss.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2023

COSMC expression as a predictor of remission in IgA nephropathy

The relationship between depression, anxiety, quality of life levels, and the chronic kidney disease stage in the autosomal dominant polycystic kidney disease

Efficacy of a novel wearable transcutaneous tibial nerve stimulation device on bladder reflex compared to implantable tibial nerve stimulation in cats

Increased co-expression of stromal HHLA2 and fibroblast activation protein in upper tract urothelial carcinoma

The measurement of basal creatinine and the diagnosis of AKI with COVID-19

How does Nephroblastomatosis impact the prognosis of unilateral Wilms tumor?