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67th Annual Meeting Abstracts
Clinical Impact of Delaying 5ARI Therapy in Men on Alpha Blockers for Symptomatic BPH in a Managed Care Population
Michael Naslund1, *Eric J. Kruep2, *Susan L. Hogue3, *Michael Eaddy2
1University of Maryland School of Medicine, Baltimore, MD;2Xcenda, LLC, Palm Harbor, FL;3GlaxoSmithKline, Research Triangle Park, NC
Introduction: Pharmacologic treatment of LUTS from an enlarged prostate (EP) commonly includes an alpha blocker (AB) and a 5-alpha reductase inhibitor (5ARI). Many clinicians use an AB for rapid symptom improvement and a 5ARI in men who continue to have bothersome symptoms and/or 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 ABs for LUTS.
Materials & Methods: Using a nationally representative database, a retrospective analysis was conducted including men aged ≥50 years treated for BPH between 2000 and 2004. Clinical outcomes for those using 5ARI therapy early (within 30 days of initiating AB) and late (>30 days after initiating AB) were compared. The likelihood of clinical progression, defined as occurrence of acute urinary retention (AUR) or prostate surgery, was assessed for each group over a 1-year period following AB initiation.
Results: Of 2,636 men in the analysis, 60.6% initiated 5ARI therapy within 30 days of AB therapy (the early cohort). Patients receiving 5ARIs early were less likely to have clinical progression (11.2% vs19.0%, P<0.0001), AUR (8.1% vs 13.2%, P<0.0001) and surgery (4.8% vs 9.5%, P<0.0001) than those treated later. Each 30-day delay in starting 5ARI therapy resulted in an average 21.1%, 18.6% and 26.7% increase in the likelihood of clinical progression, AUR and prostate surgery, respectively.
Conclusions: These results suggest that delaying 5ARI therapy in men with LUTS from EP may increase the risk of AUR and prostate surgery over the ensuing 12 months.
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