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Long-term Combination Therapy With α-Blockers and 5α-Reductase Inhibitors in Benign Prostatic Hyperplasia: Patient Adherence and Causes of Withdrawal From Medication

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Purpose: To investigate long-term therapeutic effects and patient adherence to a combination therapy of a 5α-reductase inhibitor and an α-blocker and to identify causes of withdrawal from medication in patients with clinical benign prostatic hyperplasia (BPH). Methods: BPH patients with lower urinary tract symptoms (LUTS) receiving combination therapy with follow-ups for 1–12 years were retrospectively analyzed. Therapeutic effects were assessed at baseline and annually by measuring International Prostatic Symptoms Score, quality of life index, total prostate volume (TPV), maximal flow rate, voided volume, postvoid residual volume and prostate-specific antigen level. Causes of discontinued combination therapy were also investigated. Results: A total of 625 patients, aged 40–97 years (mean, 73 years) were retrospectively analyzed. All measured parameters showed significant improvements after combination therapy. Three hundred sixty-nine patients (59%) discontinued combination therapy with a mean treatment duration of 2.2 years. The most common reasons for discontinued treatment were changing medication to monotherapy with α-blockers or antimuscarinics (124 patients, 19.8%), receiving surgical intervention (39 patients, 6.2%), and LUTS improvement (53 patients, 8.5%). Only 64 patients (10.2%) were loss to follow-up and 6 (1.0%) discontinued combined treatment due to adverse effects. Smaller TPV after short-term combination treatment caused withdrawal from combination therapy. Conclusions: BPH patients receiving long-term combination therapy showed significant improvement in all measured parameters. Changing medication, improved LUTS and choosing surgery are common reasons for discontinuing combination herapy. A smaller TPV after short-term combination treatment was among the factors that caused withdrawal from combination therapy.

Abstract

Purpose: To investigate long-term therapeutic effects and patient adherence to a combination therapy of a 5α-reductase inhibitor and an α-blocker and to identify causes of withdrawal from medication in patients with clinical benign prostatic hyperplasia (BPH). Methods: BPH patients with lower urinary tract symptoms (LUTS) receiving combination therapy with follow-ups for 1–12 years were retrospectively analyzed. Therapeutic effects were assessed at baseline and annually by measuring International Prostatic Symptoms Score, quality of life index, total prostate volume (TPV), maximal flow rate, voided volume, postvoid residual volume and prostate-specific antigen level. Causes of discontinued combination therapy were also investigated. Results: A total of 625 patients, aged 40–97 years (mean, 73 years) were retrospectively analyzed. All measured parameters showed significant improvements after combination therapy. Three hundred sixty-nine patients (59%) discontinued combination therapy with a mean treatment duration of 2.2 years. The most common reasons for discontinued treatment were changing medication to monotherapy with α-blockers or antimuscarinics (124 patients, 19.8%), receiving surgical intervention (39 patients, 6.2%), and LUTS improvement (53 patients, 8.5%). Only 64 patients (10.2%) were loss to follow-up and 6 (1.0%) discontinued combined treatment due to adverse effects. Smaller TPV after short-term combination treatment caused withdrawal from combination therapy. Conclusions: BPH patients receiving long-term combination therapy showed significant improvement in all measured parameters. Changing medication, improved LUTS and choosing surgery are common reasons for discontinuing combination herapy. A smaller TPV after short-term combination treatment was among the factors that caused withdrawal from combination therapy.

참고문헌 (18)

  1. Jacobsen SJ, "Natural history of benign prostatic hyperplasia", Urology, 58(6 Suppl 1), pp.5~16 (2001)
  2. Emberton M, "Progression of benign prostatic hyperplasia: systematic review of the placebo arms of clinical trials", BJU Int, 102, pp.981~986 (2008)
  3. Emberton M, "Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management", Int J Clin Pract, 62, pp.1076~1086 (2008)
  4. Djavan B, "A meta-analysis on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction", Eur Urol, 36, pp.1~13 (1999)
  5. Lepor H, "The impact of medical therapy on bother due to symptoms, quality of life and global outcome, and factors predicting response. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group", J Urol, 160, pp.1358~1367 (1998)
  6. Roehrborn CG, "Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a fouryear, randomized trial comparing finasteride versus placebo. PLESS Study Group", Urology, 54, pp.662~669 (1999)
  7. Gormley GJ, "The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group", N Engl J Med, 327, pp.1185~1191 (1992)
  8. McConnell JD, "The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia", N Engl J Med, 349, pp.2387~2398 (2003)
  9. Roehrborn CG, "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, pp.123~131 (2010)
  10. McVary KT, "Update on AUA guideline on the management of benign prostatic hyperplasia", J Urol, 185, pp.1793~1803 (2011)
  11. Oelke M, "EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction", Eur Urol, 64, pp.118~140 (2013)
  12. Emberton M, "Risk stratification for benign prostatic hyperplasia (BPH) treatment", BJU Int, 107, pp.876~880 (2011)
  13. Madersbacher S, "The long-term outcome of medical therapy for BPH", Eur Urol, 51, pp.1522~1533 (2007)
  14. Roehrborn CG, "Long-term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5alpha-reductase inhibitor dutasteride: results of 4-year studies", BJU Int, 96, pp.572~577 (2005)
  15. Descazeaud A, "Negative effects on sexual function of medications for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia", Prog Urol, 25, pp.115~127 (2015)
  16. Cindolo L, "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, pp.418~425 (2015)
  17. Liu CC, "Relationships between American Urological Association symptom index, prostate volume, and disease-specific quality of life question in patients with benign prostatic hyperplasia", Kaohsiung J Med Sci, 20, pp.273~278 (2004)
  18. Koh JS, "Twelve-month medication persistence in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia", Int J Clin Pract, 68, pp.197~202 (2014)

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