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Choi JD, Yoo TK, Kang JY, Jung HD, Lee JH. Clinical outcomes of withdrawing one medication from long-term combination therapy comprising α-blocker and 5α-reductase inhibitor for benign prostatic hyperplasia. Int Urol Nephrol 2023; 55:845-851. [PMID: 36763223 DOI: 10.1007/s11255-023-03476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To assess adherence to combination therapy comprising α-adrenergic blocker (AB) and 5α-reductase inhibitor (5ARI) for benign prostatic hyperplasia (BPH) in a real-world setting and whether lower urinary tract symptoms (LUTS) will relapse after discontinuing one medication from long-term combination therapy. METHODS BPH/LUTS patients receiving initial AB +5ARI combination therapy for at least 1 year between January 2012 and January 2017 were retrospectively analyzed. The patients were classified into DC-AB group (n = 65, AB discontinued) and DC-5ARI group (n = 77, 5ARI discontinued) and followed up. Clinical effects were assessed at baseline and annually using the International Prostatic Symptoms Score (IPSS), quality of life (QoL) index, total prostate volume (TPV), maximal flow rate (Qmax), and prostate-specific antigen (PSA) level. RESULTS Of total 1783 patients, 809 (45.4%) patients were identified with more than 1-year combination therapy. After withdrawal of one medication from combination therapy, the TPV progression (27.6% vs. - 10.8%; P < 0.001) and the requirement for prostate surgery (14.3% vs. 6.1%; P = 0.038) were significantly higher in the DC-5ARI group than in the DC-AB group. The rate of resuming combination therapy was significantly higher in the DC-5ARI group than in the DC-AB group (38.9% vs. 23.0%; P = 0.009). CONCLUSIONS Adherence to combination BPH therapy is relatively low. Although patients adhered to combination therapy for more than 1 year, a higher risk of requiring prostate surgery or resuming combination therapy was observed in patients who discontinued 5ARI.
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Affiliation(s)
- Jae Duck Choi
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01830, Republic of Korea
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01830, Republic of Korea
| | - Jung Yoon Kang
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01830, Republic of Korea
| | - Hyuk-Dal Jung
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01830, Republic of Korea
| | - Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01830, Republic of Korea.
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Zhou X, Lv Z, Hong S, Hu H, Tian Y, Wu S, Wang K, Wei Z, Lv L. Effectiveness and safety of acupuncture and moxibustion for chronic prostatitis: A protocol for an overview of systematic reviews and meta-analysis. Medicine (Baltimore) 2022; 101:e26116. [PMID: 36254055 PMCID: PMC9575744 DOI: 10.1097/md.0000000000026116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic prostatitis (CP) refers to a disease characterized by local pain and discomfort, urination discomfort, and quality of life. Acupuncture (ACU) and moxibustion are widely used in the treatment of CP, and the curative effect is satisfactory. Several systematic reviews (SRs) and meta-analyzes have reported the effectiveness of ACU and moxibustion in treating patients with CP. However, the evidence is not systematically integrated. This overview aims to integrate and evaluate the reliability of these SRs and the evidence generated from the ACU and moxibustion for CP meta-analysis. METHODS We will make a comprehensive retrieval in seven databases as following: Embase, Cochrane Library, Pubmed, Chinese databases SinoMed (previously called the Chinese Biomedical Database), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang Data (WF). The time is limited from the construction of the library to May 2021. We will use the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool to evaluate methodological quality. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) will be used in the report checklist to assess the quality of reports in the study. The GRADE will be used to evaluate the included SRs and meta-analysis. Our reviewers will conduct SRs, qualification evaluation, data extraction, methodological quality and evidence quality screening in pairs. The outcomes of interest include: NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), effective rate, other CP symptom scales, EPS-WBC, and adverse events. Evidence will be combined based on patient subgroups and results where appropriate. RESULTS The results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER INPLASY202150018. CONCLUSION This overview will provide comprehensive evidence of ACU and moxibustion for patients with CP.
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Affiliation(s)
- Xingchen Zhou
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhizhen Lv
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shuangwei Hong
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huijie Hu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu Tian
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shuang Wu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Kaizheng Wang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zicheng Wei
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lijiang Lv
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- * Correspondence: Lijiang Lv, The Third Clinical Medical College of Zhejiang Chinese Medical University, No. 548, Binwen Road, Hangzhou, 310053, China (e-mail: )
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Lee AW, Kenfield SA, Wang EY, Enriquez A, Oni-Orisan A, Steinman MA, Sim I, Breyer BN, Bauer SR. Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study. JMIR Form Res 2021; 5:e30762. [PMID: 34889745 PMCID: PMC8709917 DOI: 10.2196/30762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Continuous α1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men.
Objective We aim to evaluate the feasibility and usability of the PERSONAL (Placebo–Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy.
Methods We recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility.
Results We enrolled 19 men within 23 days, and 100% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74% vs 17/19, 89% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95% at baseline and at follow-up). In total, 58% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms.
Conclusions This pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men.
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Affiliation(s)
- Austin W Lee
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Elizabeth Y Wang
- Columbia University Vagelos College of Physicians and Surgeons, New York City, CA, United States
| | - Anthony Enriquez
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, United States
| | - Michael A Steinman
- Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ida Sim
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Scott R Bauer
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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4
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Taha DE, Ibrahim A, Talaat M, Abdelbaky T, Nabeeh H. Duration of Medical Treatment of Benign Prostatic Hyperplasia: Impact on Urodynamics and Post-Prostatectomy Outcome. Urol Int 2021; 106:1012-1017. [PMID: 34844249 DOI: 10.1159/000520131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess whether the duration of preoperative benign prostatic hyperplasia (BPH) medication would affect the pressure flow study (PFS) parameters and the outcome of prostate surgery or not. MATERIAL AND METHODS A retrospective study involving patients with LUTS/BPH aged 50 years or older who were compliant with BPH medications. PFS was performed prior to prostate surgery to determine BOO degree and detrusor overactivity. The efficacy of prostate surgery was determined at 3 and 6 months after surgery using the I-PSS, QOL index, Q-max, and PVR. Patients were categorized into group A, who received treatment for 12 months or less, and group B, who received the treatment for 12 months or more. The categorization starts once the patient prefers surgical intervention. RESULTS A total of 114 patients were enrolled, 50 in group A and 64 patients in group B. The mean duration, in months, of medical treatment was 9.52 ± 2.24 and 22.50 ± 4.35 in group A and group B, respectively. Pdet@Qmax is significantly (p = 0.02) higher in patients of group B (63.85 ± 11.34 vs. 94.75 ± 19.53). The detrusor overactivity amplitude is slightly higher in group A (36.42 ± 37.27 vs. 16.42 ± 28.38) (p = 0.3). The mean I-PSS, Q-max, and PVR at 1, 3, and 6 months were comparable between the groups. CONCLUSION After 24 months of BPH medical treatment, no profound PFS changes that may affect the decision of prostate surgery were observed. Patients who completed 24 months of medical treatment were safe as regards to detrusor muscle contractility with no urge to undergo prostate surgery earlier.
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Affiliation(s)
- Diaa-Eldin Taha
- Urology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Ali Ibrahim
- Urology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mona Talaat
- Radiology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Tarek Abdelbaky
- Urology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Hossam Nabeeh
- Urology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
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5
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Bauer SR, Breyer BN, Oni-Orisan A, Steinman MA, Sim I, McCulloch CE, Kenfield SA. PERSONAL: Feasibility Study Protocol for Placebo-Controlled, Randomized n-of-1 Trials of Tamsulosin for Lower Urinary Tract Symptoms. Front Digit Health 2020; 2:7. [PMID: 34713020 PMCID: PMC8521798 DOI: 10.3389/fdgth.2020.00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Lower urinary tract symptoms (LUTS) affect more than half of men over age 70 and contribute to both poor health-related quality of life and polypharmacy. Tamsulosin hydrochloride, a selective α1-blocker, is the most common medication used to treat LUTS due to presumed benign prostatic hyperplasia and is often prescribed indefinitely, although not all men benefit from long-term therapy. N-of-1 trials allow for individualized estimates of benefit and harm and could facilitate decisions regarding chronic tamsulosin therapy for LUTS, particularly among older men. Our team developed the PERSONAL (PlacEbo-controlled, Randomized, patient-Selected Outcomes, N-of-1 triALs) app to track daily urinary symptoms and medication side effects for n-of-1 trials among older men with LUTS. Materials and Methods: We will conduct a feasibility study of 20 individual randomized n-of-1 trials using the PERSONAL app to compare tamsulosin (0.4 or 0.8 mg) vs. placebo among older men taking tamsulosin for LUTS. We will include men over age 65 with a smartphone for whom temporary discontinuation of tamsulosin is safe, (e.g., no history of acute retention). Participants will work with research staff to prospectively identify the most important urinary symptoms and medication side effects that they would like to digitally track. Men will then be randomized to 2-week treatment periods of tamsulosin or placebo followed by a 1-week wash-out with placebo, for 4 distinct treatment periods and 3 wash-out periods, totaling 11 weeks. Study medications will be blinded using over-encapsulation of tamsulosin pills and matching placebo. Our primary outcomes for this study will be recruitment and retention of eligible men, completion rates of n-of-1 trials and daily questionnaires using the PERSONAL app, and participants' perceived usefulness of their n-of-1 trial for determining whether tamsulosin is effective for them. Linear mixed effects models with individual-specific intercepts and intervention effects will also be used to estimate within-individual effects of tamsulosin. Discussion: The goal of this innovative study is to establish feasibility and acceptability of using a mobile health app and n-of-1 trials to provide older men with individualized estimates of benefits and harms of chronic tamsulosin therapy for LUTS.
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Affiliation(s)
- Scott R Bauer
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Veterans Affairs Medical Center, San Francisco, San Francisco, CA, United States
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, United States
| | - Michael A Steinman
- Veterans Affairs Medical Center, San Francisco, San Francisco, CA, United States.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ida Sim
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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6
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Room for improvement in reporting of trials discontinuing long-term medication: a systematic review. J Clin Epidemiol 2020; 119:65-74. [DOI: 10.1016/j.jclinepi.2019.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/20/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022]
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7
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van der Worp H, Jellema P, Hordijk I, Lisman-van Leeuwen Y, Korteschiel L, Steffens MG, Blanker MH. Discontinuation of alpha-blocker therapy in men with lower urinary tract symptoms: a systematic review and meta-analysis. BMJ Open 2019; 9:e030405. [PMID: 31699724 PMCID: PMC6858108 DOI: 10.1136/bmjopen-2019-030405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We aimed to synthesise the available data for the effect of stopping alpha-blocker therapy among men with lower urinary tract symptoms. The focus was on symptom, uroflowmetry and quality of life outcomes, but we also reviewed the adverse events (AEs) and the number of patients who restarted therapy. DATA SOURCES We searched MEDLINE/PubMed, EMBASE/Ovid and The Cochrane Central Register of Controlled Trials from inception to May 2018. ELIGIBILITY CRITERIA We selected studies regardless of study design in which men were treated with an alpha-blocker for at least 3 months and in which the effects of alpha-blocker discontinuation were subsequently studied. Only controlled trials were used for the primary objective. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed the risk of bias for the controlled studies only using the Cochrane Collaboration's tool for assessing risk of bias. Data were pooled using random-effects meta-analyses. RESULTS We identified 10 studies (1081 participants) assessing the primary objective. Six studies (733 participants) assessed differences in AEs between continuation and discontinuation, and six studies (501 participants) reported the numbers of subjects that restarted treatment after discontinuation. No studies in primary care were identified. After discontinuing monotherapy, symptom scores increased and peak flow rates decreased at 3 and 6 months, but not at 12 months; however, neither parameter changed when alpha-blockers were stopped during combination therapy. Small differences in post-void residual volumes and quality of life scores were considered clinically irrelevant. We also found that 0%-49% of patients restarted after stopping alpha-blocker therapy and that AEs did not increase with discontinuation. CONCLUSIONS Discontinuing alpha-blocker monotherapy leads to a worsening compared with continuing therapy. Discontinuing the alpha-blocker after combination therapy had no significant effects on outcomes in either the short or long term. Discontinuation may be appropriate for the frail, elderly or those with concomitant illness or polypharmacy. However, studies in primary care are lacking. PROSPERO REGISTRATION NUMBER CRD42016032648.
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Affiliation(s)
- Henk van der Worp
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Petra Jellema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ilse Hordijk
- Urology, Isala Hospitals, Zwolle, The Netherlands
| | - Yvonne Lisman-van Leeuwen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Effects of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials. Br J Gen Pract 2019; 68:e663-e672. [PMID: 30249607 DOI: 10.3399/bjgp18x699041] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polypharmacy is becoming more prevalent and evaluation of appropriateness of medication use is increasingly important. The primary care physician often conducts the deprescribing process; however, there are several barriers to implementing this. AIM To examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community, that is, primary care (or general practice) and nursing homes. DESIGN AND SETTING This systematic review included randomised controlled trials published in 2005-2017, which studied withdrawal of long-term drugs prescribed in primary care settings and compared continuing medication with discontinuing. METHOD PubMed and EMBASE searches were conducted and the extracted data included the number of patients who successfully stopped medication and the number of patients who experienced relapse of symptoms or restarted medication. RESULTS A total of 27 studies reported in 26 papers were included in this review. The number of participants in the studies varied from 20 to 2471 and the mean age of participants ranged from 50.3 years to 89.2 years. The proportion of patients who successfully stopped their medication varied from 20% to 100%, and the range of reported relapse varied from 1.9% to 80%. CONCLUSION Only a few studies have examined the success rate and safety of discontinuing medication in primary care, and these studies are very heterogeneous. Most studies show that deprescribing and cessation of long-term use seem safe; however, there is a risk of relapse of symptoms. More research is needed to advise physicians in making evidence-based decisions about deprescribing in primary care settings.
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Chen JL, Jiang YH, Lee CL, Kuo HC. Precision medicine in the diagnosis and treatment of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Tzu Chi Med J 2019; 32:5-13. [PMID: 32110513 PMCID: PMC7015008 DOI: 10.4103/tcmj.tcmj_107_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 01/25/2023] Open
Abstract
Male lower urinary tract symptoms (LUTSs) are highly prevalent in men and the incidence increases with aging. The pathophysiology of male LUTSs might be bladder outlet dysfunctions such as bladder neck (BN) dysfunction, benign prostatic obstruction, and poor relaxation of external sphincter and bladder dysfunctions such as detrusor overactivity (DO), detrusor underactivity, DO, and inadequate contractility. Male LUTSs include voiding and storage symptoms, and precision diagnosis should not be done based on the symptoms alone. Videourodynamic study provides a thorough look at the bladder and bladder outlet and can clearly demonstrate the underlying pathophysiology when the initial medication fails to relieve LUTS. Medical treatment should be given based on the underlying pathophysiology of LUTS, and surgical intervention to remove prostate should only be performed when a definite bladder outlet obstruction due to prostatic obstruction has been confirmed by invasive urodynamic study.
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Affiliation(s)
- Jing-Liang Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Cheng-Ling Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Matsumoto T, Hatakeyama S, Narita T, Yoneyama T, Hashimoto Y, Ohyama C. Evaluating the effects of switching from dutasteride to tadalafil in benign prostatic hyperplasia patients with lower urinary tract symptoms: A randomized, open‐label, multicenter study. Int J Urol 2019; 26:522-523. [DOI: 10.1111/iju.13908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Teppei Matsumoto
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Shingo Hatakeyama
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Takuma Narita
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Takahiro Yoneyama
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Yasuhiro Hashimoto
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Chikara Ohyama
- Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan
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Serati M, Andersson KE, Dmochowski R, Agrò EF, Heesakkers J, Iacovelli V, Novara G, Khullar V, Chapple C. Systematic Review of Combination Drug Therapy for Non-neurogenic Lower Urinary Tract Symptoms. Eur Urol 2019; 75:129-168. [PMID: 30293906 DOI: 10.1016/j.eururo.2018.09.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/14/2018] [Indexed: 01/05/2023]
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12
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Ahn HS, Kim SJ, Choi JB, Choo SH, Shim KH, Kim SI. Long-term cost comparison between surgical and medical therapy for benign prostatic hyperplasia: a study using hospital billing data. BJU Int 2018; 123:E79-E85. [PMID: 30303597 DOI: 10.1111/bju.14584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyse actual long-term medical treatment of benign prostatic hyperplasia (BPH) and compare the incurred cost with that of patients with BPH who underwent early surgery. PATIENTS AND METHODS Patients who were first diagnosed with BPH from 1 January 2008 to 31 December 2010 were identified using the Clinical Data Warehouse. Hospital billing data generated by the electronic hospital management system were collected until December 2015. For outpatient care, only procedures, materials and drugs directly related to the management of BPH were selected for the analysis. For inpatient care, all procedures, materials and drugs ordered on dates with continuity with BPH surgery date were included. The primary endpoint of the study was the total treatment-related direct costs of patients undergoing a long-term curative medical therapy for BPH (Group 1), which was arbitrarily defined as any medical therapy including a 5α-reductase inhibitor with a minimum medication possession ratio of 0.5 during ≥5 consecutive years, or ≥1 year until BPH surgery due to medical therapy failure. In all, 70 patients who underwent BPH surgery at <1 year of initial visit served as controls (Group 2). RESULTS Amongst 137 patients in the Group 1, four patients underwent BPH surgery at a median of 57.8 months after the initial visit (2.9%). At a median follow-up of 76 months, the mean total treatment cost was significantly higher in Group 1 than in Group 2 ($3987 vs $3036 [USA dollars], P < 0.001). Similarly, the mean 'out-of-pocket' cost was significantly higher in Group 1 than in Group 2 ($1742 vs $1436, P = 0.005). When a linear increment of annual BPH treatment cost is assumed for Group 1 and all costs are assumed to be produced within the first year for Group 2, the total and out-of-pocket costs became equal at the end of the fifth year of medical treatment. For both total and out-of-pocket costs, medication-related costs occupied the largest proportion, exceeding half of the costs. CONCLUSIONS We suggest patient counselling at the beginning of BPH treatment should include the likelihood that the cumulative out-of-pocket cost at 5 years of continuous medication will exceed that of early surgery. Our cost study using hospital billing data extractable from the electronic hospital management system may be a good model for cost studies that could provide valuable information to health providers and payers.
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Affiliation(s)
- Hyun Soo Ahn
- Department of Urology, Ajou University School of Medicine, Suwon, South Korea
| | - Se Joong Kim
- Department of Urology, Ajou University School of Medicine, Suwon, South Korea
| | - Jong Bo Choi
- Department of Urology, Ajou University School of Medicine, Suwon, South Korea
| | - Seol Ho Choo
- Department of Urology, Ajou University School of Medicine, Suwon, South Korea
| | - Kang Hee Shim
- Department of Urology, Ajou University School of Medicine, Suwon, South Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, South Korea
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Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol 2016; 82:583-623. [PMID: 27077231 PMCID: PMC5338123 DOI: 10.1111/bcp.12975] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/23/2016] [Accepted: 04/12/2016] [Indexed: 12/31/2022] Open
Abstract
AIMS Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and health outcomes in older adults. METHODS Specified databases were searched from inception to February 2015. Two researchers independently screened all retrieved articles for inclusion, assessed study quality and extracted data. Data were pooled using RevMan v5.3. Eligible studies included those where older adults had at least one medication deprescribed. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, psychological and physical health outcomes, quality of life, and medication usage (e.g. successful deprescribing, number of medications prescribed, potentially inappropriate medication use). RESULTS A total of 132 papers met the inclusion criteria, which included 34 143 participants aged 73.8 ± 5.4 years. In nonrandomized studies, deprescribing polypharmacy was shown to significantly decrease mortality (OR 0.32, 95% CI: 0.17-0.60). However, this was not statistically significant in the randomized studies (OR 0.82, 95% CI 0.61-1.11). Subgroup analysis revealed patient-specific interventions to deprescribe demonstrated a significant reduction in mortality (OR 0.62, 95% CI 0.43-0.88). However, generalized educational programmes did not change mortality (OR 1.21, 95% CI 0.86-1.69). CONCLUSIONS Although nonrandomized data suggested that deprescribing reduces mortality, deprescribing was not shown to alter mortality in randomized studies. Mortality was significantly reduced when applying patient-specific interventions to deprescribe in randomized studies.
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Affiliation(s)
- Amy T Page
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia
| | - Rhonda M Clifford
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia
| | - Kathleen Potter
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia
| | - Darren Schwartz
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia
- Graylands Hospital, Mt Claremont, Western Australia, Australia
| | - Christopher D Etherton-Beer
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia
- Royal Perth Hospital, Perth, Western Australia, Australia
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Hobbs CP, Henderson JM, Malone PR. Living with a 100 ml prostate: Outcomes over a decade. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415814554851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this article is to determine outcomes and guide the management of patients with a prostate volume of 100 ml or greater. Patients and methods: A database of patients undergoing transrectal ultrasound (TRUS)-guided biopsy from 1994 to 1999 was analysed. Records of those with a prostate of 100 ml or greater were reviewed. Results: A total of 63 patients were included in the study with a mean follow-up of 11 years. Initial TRUS-guided biopsy yielded prostate cancer (CaP) in six of 63 (10%). Twenty-six of 63 (41%) underwent repeat biopsies. CaP was ultimately diagnosed in 13/63 (21%). Prostate-specific antigen (PSA) levels were erratic over time, making monitoring difficult. The PSA coefficient of variation in benign prostates ranged from 8.9% to 48.6% in the year following biopsy. Twenty-one of 50 (42%) with benign prostates experienced acute urinary retention (AUR), 31/50 (62%) haematuria and 43/50 (86%) received treatment for lower urinary tract symptoms (LUTS). Twenty-six of 50 (52%) received 5-alpha reductase inhibitors (5ARI), 11/50 (22%) α-blockers and 28/50 (56%) surgery. Thirteen of 15 (87%) experienced further symptoms when treated for less than two years with 5ARI versus five of 16 (31%) receiving long-term treatment (mean duration 8.1 years). Fifteen of 25 (60%) experienced haematuria following TURP and 14/25 (56%) required further treatment. Conclusion: Large prostates cause considerable symptoms prompting multiple medical consultations and investigations. PSA monitoring in this group is difficult, leading to repeated biopsies of benign prostates. Long-term 5ARI treatment should be considered to reduce progression to AUR, the incidence of haematuria and to facilitate PSA monitoring. Newer treatment modalities such as holmium laser enucleation (HoLEP) should be considered ahead of TURP. When TURP is performed, 5ARI treatment should be considered post-operatively. This group of men should have close urological follow-up.
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