Early Symptom Improvement and Discontinuation of 5-α-Reductase Inhibitor (5ARI) Therapy in Patients With Benign Prostatic Hyperplasia (BPH)

Abstract

Pharmacological treatment options for benign prostatic hyperplasia (BPH) commonly include α-blocker (AB) and 5-α-reductase inhibitor (5ARI) agents, which have separate but important attributes that carry clinical implications in terms of improvement of lower-urinary tract symptoms (LUTS) and clinical disease progression. This study hypothesized that administering AB therapy concomitantly with newly started 5ARI treatment would reduce the likelihood of 5ARI discontinuation through early symptom improvement. This retrospective analysis of the PharMetrics Integrated Medical and Pharmaceutical Database included men aged ≥50 years with ≥1 medical claim of BPH diagnosis and ≥1 prescription claim of a 5ARI with or without an AB. Patients initiating 5ARI monotherapy were propensity score matched with patients initiating combination AB + 5ARI therapy (1:1), with 5ARI time to discontinuation (30-day gap in treatment) compared between groups utilizing survival analysis techniques. The percentage of patients adherent to 5ARI therapy based on medication possession ratio (MPR) was assessed. After 180 days of follow-up, 61.7% of the combination therapy arm versus 59.2% of the monotherapy arm remained on therapy. Combination therapy patients were 10% less likely to discontinue 5ARI treatment (hazard ratio = 0.904; P = .006) and were more likely to be adherent when adherence was defined as MPR ≥70% and ≥75%. Based on an assessment of claims data, initiating AB with 5ARI therapy is associated with a lower rate of 5ARI discontinuation compared with 5ARI monotherapy. Early symptom relief from AB therapy may contribute to a lower discontinuation rate for concomitant 5ARI therapy.