Impact of delaying 5-alpha reductase inhibitor therapy in men on alpha-blocker therapy to treat BPH: assessment of acute urinary retention and prostate-related surgery

Abstract

Objective:

Pharmacologic treatment of lower urinary tract symptoms from benign prostatic hyperplasia (BPH) commonly includes α-blockers (ABs) and 5α-reductase inhibitors (5ARIs). Many clinicians use ABs for rapid symptom control and 5ARIs to modify long-term disease progression. The purpose of this study was to assess the clinical impact of delayed 5ARI therapy in patients treated with AB for lower urinary tract symptoms.

Research design and methods:

Using two nationally representative databases, two retrospective analyses were conducted including patients aged ≥50 years treated for BPH between 2000 and 2007. Clinical outcomes for those using add-on 5ARI therapy early (within 30 days of initiating AB) and late (>30 days after initiating AB) were compared. Likelihood of clinical progression, defined as the presence of acute urinary retention (AUR) and prostate surgery, was assessed over 1 year after AB initiation, and modeled as a function of the treatment cohorts and the following baseline covariates: AUR, BPH stage, Charlson Comorbidity Index, age, and number of unique diagnosis codes, unique non-BPH-related classes of prescriptions filled, and specialty care.

Results:

Of 6896 men included in the analyses, approximately 60% initiated 5ARI therapy within 30 days of AB therapy (the early cohort). Patients in the early cohort were less likely to have clinical progression. Each 30-day delay in starting 5ARIs resulted in an increased likelihood of overall clinical progression (average 21.1%), AUR (average 18.6%), and prostate-related surgery (average 26.7%).

Conclusions:

These results suggest that delaying 5ARI therapy in men with BPH increases the risk of AUR and prostate surgery.

Limitations:

Confounding factors, such as symptom severity and prostate volume, may have influenced the findings of the study.

Key words: :

• 5-alpha reductase inhibitor
• Acute urinary retention
• Alpha-blocker
• Benign prostatic hyperplasia
• Enlarged prostate
• Prostate surgery

Transparency

Declaration of funding

GlaxoSmithKline funded this study and paper.

Declaration of financial/other relationships

M.N. has disclosed that he received financial support from GSK for the production of this study and paper, and that he has received research support from Ferring. He has also disclosed that he is on the speakers’ bureau of GSK, sanofi-aventis and Boehringer Ingelheim. S.L.H. had disclosed that she is employed by GSK. GSK provided funding to M.T.E., E.J.K. and M.B.S., who are employed by Xcenda, to perform research and assist in the development of this manuscript.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors have disclosed that they had no outside editorial assistance in preparing this manuscript.