Continuation rates of alpha-blockers mono-therapy in adult men, prescribed by urologists or general practitioners: a pharmacy-based study

Ilse M J Hordijk,Martijn G Steffens,Eelko Hak,Marco H Blanker

doi:10.1007/s00345-018-2557-3

Ilse M J Hordijk, Martijn G Steffens + Show 2 more

Open Access

https://doi.org/10.1007/s00345-018-2557-3

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Abstract

Purposeα-Blockers are commonly used for the treatment of male lower urinary tract symptoms (LUTS). The Dutch GP guideline on male LUTS contains an advice to discontinue treatment after 3–6 months of successful treatment. The guideline for urologists does not support this advice. It is unclear if these differences lead to other patterns of (dis)continuation of α-blockers. We aim to study continuation rates of α-blockers, prescribed by a urologist or a general practitioner (GP), and to predict discontinuation after 1 year.MethodsWe conducted a retrospective inception cohort study on prescription patterns of α-blockers among Dutch men between 2006 and 2014, using the IADB.nl pharmacy prescription database from the University of Groningen. We selected men aged 30 years or older with a first α-blocker prescription between 2006 and 2013, and analysed continuation of prescriptions.ResultsThe database included 12,191 individual patients with at least one α-blocker prescriptions from a urologist (44.5%) or a GP (55.5%). The median treatment period for patients who started in the GPs office was 210 days, compared to 150 days for patients with a prescription from a urologist. Of all patients, 60.3% (GP prescriptions) and 66.1% (urologists’ prescriptions) had discontinued treatment (Chi-square p < 0.001). Discontinuation rates were age dependent with higher rates in the youngest age groups.ConclusionIn this study, the discontinuation rate 1 year after the initiation of treatment was high. Although Dutch GP’s and urologist’s guidelines differ with respect to a discontinuation advice, we could not find clinically relevant difference in (temporary) discontinuation rates.

Highlights

The pharmacological treatment in male lower urinary tract symptoms (LUTS) generally starts with α-blocker therapy [1,2,3]
We identified 12,191 individual patients with one or more α-blocker prescriptions
60.3% and 66.1% of, respectively, general practitioner (GP)’s and urologists’ patients had discontinued treatment (Chi-square p < 0.001) within 1 year after initiating α-blocker treatment

Summary

Introduction

The pharmacological treatment in male LUTS generally starts with α-blocker therapy [1,2,3]. The Dutch general practitioner (GP) guideline “male LUTS” contains an advice to discontinue α-blocker therapy after 3–6 months of use [3] This advice is based on the overall variable LUTS severity over time [4], but has no further evidence base. The guideline of Dutch urologists does not support this recommendation; neither does the guideline of the European Association of Urologists (EAU) [2] In the latter, discontinuation of α-blockers is only suggested for men who receive combination treatment with a 5-α-reductase inhibitor [2]. Discontinuation of α-blockers is only suggested for men who receive combination treatment with a 5-α-reductase inhibitor [2] Whether this difference in guideline advises leads to other prescription patterns between GPs and urologists has not been studied.

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