Kombinationsbehandlung des BPS mit Tamsulosin und Finasterid

Population pharmacokinetics of tamsulosine in patients with benign prostatic hyperplasia

PURPOSE

The study aimed to determine the typical clearance and volume of distribution values of tamsulosin in patients with benign prostatic hyperplasia (BPH), and to identify factors with a measurable impact on the drug's elimination.

METHODS

This open-label, single-arm population pharmacokinetic study involved 65 adult men with BPH who had been on tamsulosin therapy for at least seven days. The steady-state serum concentrations of tamsulosin were measured using liquid chromatography-tandem quadrupole mass spectrometry. Population pharmacokinetic parameters, their variability, and influencing factors were estimated based on a two-compartment pharmacokinetic model using NONMEM software.

RESULTS

The estimated tamsulosin clearance in BPH patients was 0.719 L/h, and the steady-state volume of distribution was 32 L. Neither renal nor liver function parameters had a statistically significant effect on tamsulosin clearance. However, a positive correlation was observed between hemoglobin levels and tamsulosin clearance in the BPH patient cohort.

CONCLUSION

Our investigation reveals significant associations between tamsulosin pharmacokinetics and specific characteristics of patients with lower urinary tract symptoms (LUTS) due to BPH. The study highlights that tamsulosin clearance is associated with hemoglobin levels in patients with LUTS/BPH. This study underscores the importance of considering patient-specific factors when managing BPH treatment with tamsulosin, emphasizing associations rather than causative relationships.

Smart UV spectrophotometric methods based on simple mathematical filtration and classical methods for the simultaneous determination of tamsulosin and solifenacin: A comparative study of efficacy and spectral resolution

Treatment protocols combining tamsulosin and solifenacin proved better management of the complicated urinary tract symptoms. The pharmaceutical preparations of tamsulosin and solifenacin suffered from the high difference in their ratio, 0.4 mg tamsulosin and 6 mg solifenacin, and strong spectral overlap. Here, we developed four simple, accurate and selective spectrophotometric methods based on simple mathematical manipulations. These methods require the simplest mathematical filtration using short steps performed using built-in functions of the spectrophotometer operating software utilizing zero-order or derivative spectra. These methods are namely absorption correction method (ACM), induced dual-wavelength (IDW), absorptivity factor method (AFM) and first derivative method (D1). The linear ranges were 15-70 µg/ml and 100-1200 µg/ml for TAM and SFN, respectively. The limits of quantitation were in the range of 3.8-4.05 µg/ml and 23.34-59.05 µg/ml, while the limits of detection were in the range of 1.25-1.34 µg/ml and 7.7-24.6 µg/ml for TAM and SFN, respectively. All validation parameters investigated as per ICH guidelines. A statistical comparison executed for the proposed methods with each other and with the reported methods showed no significant difference between the proposed and the reported methods.

Persistence and adherence to dutasteride/tamsulosin fixed-dose versus free-combination alpha blocker/5ARI therapy in patients with benign prostate hyperplasia in Germany

Objective: To evaluate real-world persistence and adherence in patients with benign prostate hyperplasia (BPH) receiving a fixed-dose combination of dutasteride plus tamsulosin (DUT-TAM FDC) versus α-blocker plus 5-α reductase inhibitor (AB/5ARI) free-combination therapy. Materials and methods: This retrospective, observational cohort study utilized the German IMS LRx (IQVIA) database. Patients ≥ 45 years old with BPH receiving DUT-TAM FDC or AB/5ARI free-combination therapy from July 1, 2011 to November 30, 2017 were included. Data were analyzed for 48 months from index date (date of first prescription). Persistence, measured as time to discontinuation (defined as a 90-day gap in therapy), was evaluated using Kaplan-Meier curves (log-rank tests). Adherence, measured as medication possession ratio (MPR), was based on a comparison of mean prescribing duration and expected treatment duration. Results: A total of 141,667 patients were included (DUT-TAM FDC, n = 86,057; free AB/5ARI: n = 55,610). Small differences in persistence were observed between treatment arms. At month 12, 41.8% of DUT-TAM FDC-treated and 41.0% of AB/5ARI free-combination therapy-treated patients were persistent; at month 24, 28.2% and 27.1% were persistent, respectively. A higher proportion of DUT-TAM FDC-treated patients had MPR ≥ 0.80, ≥ 0.75 and ≥ 0.70 compared with AB/5ARI free-combination therapy (p < 0.0001). Conclusion: Small differences observed in persistence between treatment arms may not translate to meaningful clinical relevance. Adherence was significantly better in the FDC arm, which may be clinically relevant as improved adherence is associated with better outcomes. Persistence and adherence to BPH therapy in Germany is low; further studies exploring the reasons behind this are required.