MP10-09 THE REAL-WORLD EFFECTIVENESS OF PREVENTIVE PHARMACOLOGICAL THERAPY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP10-09 THE REAL-WORLD EFFECTIVENESS OF PREVENTIVE PHARMACOLOGICAL THERAPY John Hollingsworth, Mary Oerline, Ryan Hsi, Joseph Crivelli, Noah Krampe, John Asplin, and Vahakn Shahinian John HollingsworthJohn Hollingsworth More articles by this author , Mary OerlineMary Oerline More articles by this author , Ryan HsiRyan Hsi More articles by this author , Joseph CrivelliJoseph Crivelli More articles by this author , Noah KrampeNoah Krampe More articles by this author , John AsplinJohn Asplin More articles by this author , and Vahakn ShahinianVahakn Shahinian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most efficacy results supporting preventive pharmacological therapy (PPT) used to reduce kidney stone recurrence are based on composite outcomes largely driven by imaging findings. Because these findings are surrogates for things about which patients and their clinicians care, we conducted an observational study to determine whether PPT use led to fewer symptomatic kidney stone events, requiring emergency department (ED) visit, hospitalization, or surgery. METHODS: We identified a cohort of Medicare enrollees who had a 24-hour urine collection processed by a large central laboratory (2011-2016). We linked their clinical data with their pharmacy and medical claims. Among the subset with at least one biochemistry abnormality, we distinguished those who were prescribed guideline-concordant PPT (i.e., thiazides for hypercalciuria, alkali citrate therapy for hypocitraturia or low urine pH, uric acid lowering agents for hyperuricosuria) from those who were not. We differentiated between adherent and nonadherent PPT users based on the proportion of days covered method. We fit multivariate Cox models to estimate the hazard of a symptomatic stone event as a function of PPT use. RESULTS: In total, 7,230 patients met criteria, 55% of whom had hypocitraturia. Sixty-nine percent were untreated, and 31% were prescribed concordant PPT (alkali citrate therapy was used in 66%). Compared to untreated patients, those prescribed concordant therapy and adhered to their medication had a 38% lower hazard of ED visit (P<0.01) and a 46% lower hazard of hospitalization (P=0.04). Put differently, compared to untreated patients, concordant/adherent patients had lower 2-year predicted probabilities of ED visit (4.6% vs. 7.3%) and hospitalization (1.1% vs. 2.0%) (P<0.05 for each comparison). A similar pattern was noted for stone directed surgery but was not significant (Figure 1). CONCLUSIONS: Our findings help strengthen the evidence base for PPT use, providing real-world data on its clinical effectiveness. Source of Funding: National Institute of Diabetes and Digestive and Kidney Diseases R01DK121709 (to J.H.) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e117 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Hollingsworth More articles by this author Mary Oerline More articles by this author Ryan Hsi More articles by this author Joseph Crivelli More articles by this author Noah Krampe More articles by this author John Asplin More articles by this author Vahakn Shahinian More articles by this author Expand All Advertisement PDF downloadLoading ...