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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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Armando LG, Baroetto Parisi R, Remani E, Esiliato M, Rolando C, Vinciguerra V, Diarassouba A, Cena C, Miglio G. Persistence to Medications for Benign Prostatic Hyperplasia/Benign Prostatic Obstruction-Associated Lower Urinary Tract Symptoms in the ASL TO4 Regione Piemonte (Italy). Healthcare (Basel) 2022; 10:healthcare10122567. [PMID: 36554090 PMCID: PMC9778582 DOI: 10.3390/healthcare10122567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pharmacological treatment of benign prostatic hyperplasia (BPH)/benign prostatic obstruction (BPO)-associated lower urinary tract symptoms (LUTS) aims at improving patients' quality of life by managing urinary symptoms and preventing complications and disease progression. However, continuous use of drugs to treat BPH/BPO-associated LUTS decreases over time. The aim of this retrospective observational study was to describe use of α1-adrenoceptor antagonists (ABs) and steroid 5α-reductase inhibitors (5ARIs) by adult (age ≥ 40 years) men in the ASL TO4, a Local Health Authority in the northern area of the city of Turin (Italy). METHODS Persistence measures were adopted as a robust, informative, and feasible way to understand medication-taking behavior and to assess patient compliance. RESULTS A total of 4309 men (median age 71 years) were enrolled. Monotherapy was the treatment option prescribed to the largest part of the study population. However, ≥two drugs were prescribed to a substantial proportion of men (23%). Men prescribed alfuzosin or dutasteride had significantly greater persistence, which decreased over time. CONCLUSIONS Unmet needs and areas of intervention for healthcare systems aimed at improving the use of drugs for BHP/BPO-associated LUTS in the ASL TO4 Regione Piemonte were identified.
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Affiliation(s)
- Lucrezia Greta Armando
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Raffaella Baroetto Parisi
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Elisa Remani
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Mariangela Esiliato
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Cristina Rolando
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Valeria Vinciguerra
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Abdoulaye Diarassouba
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Clara Cena
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Gianluca Miglio
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
- Competence Centre for Scientific Computing, University of Turin, Corso Svizzera 185, 10149 Turin, Italy
- Correspondence: ; Tel.: +39-0116707150
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Park S, Lee KS, Choi M, Lee M. Factors associated with quality of life in patients with benign prostatic hyperplasia, 2009-2016. Medicine (Baltimore) 2022; 101:e30091. [PMID: 36086750 PMCID: PMC9512327 DOI: 10.1097/md.0000000000030091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
This study analyzed the factors affecting the health-related quality of life of patients with benign prostatic hyperplasia (BPH) according to age. We also aimed to determine appropriate strategies to improve their quality of life. Data from the Korea Health Panel Survey (2009-2016) were used in this study. A total of 3806 patients with BPH were divided into 2 groups: younger adults (aged under 65 years) and older adults (aged over 65 years). In addition, a logistic regression analysis was conducted to identify factors affecting the quality of life of young and older patients with BPH. In younger adult patients with BPH, the higher the level of education, the higher the quality of life by a factor of 1.379, and the more intense the physical activity, the lower the quality of life by a factor of 0.791. Also, the longer the sitting time, the lower the quality of life by a factor of 0.765. In contrast, for older adult patients with BPH, the quality of life improved by factors of 1.601 and 2.921, respectively, for health insurance and higher income level. In addition, it was found that the quality of life decreased by a factor of 0.754 in patients who drink alcohol. In order to improve the quality of life of the middle-aged adult population with BPH, it is necessary to reduce sitting time through constant physical activity. Moreover, the cost of medical care should be reduced and the quality of life increased through reductions in surgical treatment, as the burden of medical expenses will degrade the quality of life for older adults.
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Affiliation(s)
- Sewon Park
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Kyu-Sung Lee
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mankyu Choi
- Department of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
| | - Munjae Lee
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea
- Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea
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Liao X, Bian H, Zheng X, Ai J, Yang L, Liu L, Qiu S, Wei Q. Association of the inflammatory potential of diet and lower urinary tract symptoms among men in the United States. Aging Male 2021; 24:72-79. [PMID: 34233582 DOI: 10.1080/13685538.2021.1920911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Inflammation is crucial in the pathogenesis of lower urinary tract symptoms (LUTS) in men. Diet modulates inflammation. Therefore, diet could be a modifiable factor in male LUTS prevention and treatment. We aimed to investigate the association between dietary inflammatory potential and male LUTS. METHODS We used two cycles of National Health and Nutrition Examination Survey (NHANES) with self-report LUTS data. We calculated the dietary inflammatory index (DII) based on a 24 h diet recall and evaluated male LUTS. Clinical LUTS was defined as two or more coexisting symptoms. We used univariate and multivariate logistic regression models, the smooth curve fitting to analyze the relationship between clinical LUTS and the DII score. Subgroup analyses were conducted. RESULTS We observed a positive non-linear relationship between clinical LUTS and DII. We found that when DII was higher than the inflection point 2.39, a 1-unit increase in DII was associated with 26.1% higher adjusted odds of clinical LUTS. Subgroup analyses showed that the DII score was only positively correlated with clinical LUTS risk in non-drinkers, smokers, and non-obese people (DII >2.39). CONCLUSIONS Inflammation might be the key mechanism bridging dietary consumption to male LUTS. Excessive pro-inflammatory food intake (DII >2.39) warrants special vigilance, especially for non-drinkers, smokers, and non-obese men.
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Affiliation(s)
- Xinyang Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Haiyang Bian
- Department of Epidemiology and Biostatistics, Institute of Reproductive and Child Health, Peking University School of Public Health, Beijing, PR China
| | - Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
- Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
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Park S, Ryu JM, Lee M. Quality of Life in Older Adults with Benign Prostatic Hyperplasia. Healthcare (Basel) 2020; 8:healthcare8020158. [PMID: 32512888 PMCID: PMC7349344 DOI: 10.3390/healthcare8020158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 12/01/2022] Open
Abstract
The purpose of this study is to identify factors that affect health-related quality of life (HRQOL) of older patients with Benign Prostatic Hyperplasia (BPH) and suggest ways to improve the same. Through this, we will improve the self-management practice of patients and promote the treatment of BPH in older patients. The 2015 Korea Health Panel Survey data were used in this study. A total of 422 BPH patients aged 65 or older were included. Logistic regression analysis was conducted to identify factors affecting the HRQOL of older patients with BPH. General characteristics of factors affecting older patients with BPH included income level and type of insurance. In addition, among medical-related characteristics and health behavior factors, subjective health status, unmet medical care needs, moderate physical activity, sitting time, and drinking influenced the HRQOL. Therefore, in order to improve the HRQOL of adult patients with BPH, it is necessary to improve medical accessibility by strengthening primary care. In addition, it is necessary to increase the amount of activity in daily life through healthcare medical devices.
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Cindolo L, Pirozzi L, Sountoulides P, Fanizza C, Romero M, Castellan P, Antonelli A, Simeone C, Tubaro A, de Nunzio C, Schips L. Patient's adherence on pharmacological therapy for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) is different: is combination therapy better than monotherapy? BMC Urol 2015; 15:96. [PMID: 26391357 PMCID: PMC4578263 DOI: 10.1186/s12894-015-0090-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/11/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent studies showed that the non-adherence to the pharmacological therapy of patients affected by BPH-associated LUTS increased the risk of clinical progression of BPH. We examined the patients adherence to pharmacological therapy and its clinical consequences in men with BPH-associated LUTS looking at the differences between drug classes comparing mono vs combination therapy. METHODS A retrospective, population-based cohort study, using prescription administrative database and hospital discharge codes from a total of 1.5 million Italian men. Patients ≥ 40 years, administered alpha-blockers (AB) and 5alpha-reductase inhibitors (5ARIs), alone or in combination (CT), for BPH-associated LUTS were analyzed. The 1-year and long term adherence together with the analyses of hospitalization rates for BPH and BPH-related surgery were examined using multivariable Cox proportional hazards regression model and Pearson chi square test. RESULTS Patients exposed to at least 6 months of therapy had a 1-year overall adherence of 29 % (monotherapy AB 35 %, monotherapy 5ARI 18 %, CT 9 %). Patient adherence progressively declined to 15 %, 8 % and 3 % for AB, 5ARI, and CT, respectively at the fifth year of follow up. Patients on CT had a higher discontinuation rate along all the follow-up compared to those under monotherapy with ABs or 5ARIs (all p < 0.0001). Moreover, CT was associated with a reduced risk of hospitalization for BPH-related surgery (HR 0.94; p < 0.0001) compared to AB monotherapy. CONCLUSIONS Adherence to pharmacological therapy of BPH-associated LUTS is low and varies depending on drugs class. Patients under CT have a higher likelihood of discontinuing treatment for a number of reasons that should be better investigated. Our study suggests that new strategies aiming to increase patient's adherence to the prescribed treatment are necessary in order to prevent BPH progression.
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Affiliation(s)
- Luca Cindolo
- Department of Urology, "S.Pio da Pietrelcina" Hospital, via San Camillo de Lellis, 1-66054, Vasto, Italy.
| | - Luisella Pirozzi
- Department of Clinical Pharmacology and Epidemiology, Fondazione "Mario Negri Sud", Santa Maria Imbaro, Italy.
| | | | - Caterina Fanizza
- Department of Clinical Pharmacology and Epidemiology, Fondazione "Mario Negri Sud", Santa Maria Imbaro, Italy.
| | - Marilena Romero
- Department of Clinical Pharmacology and Epidemiology, Fondazione "Mario Negri Sud", Santa Maria Imbaro, Italy.
| | - Pietro Castellan
- Department of Urology, "SS. Annunziata" Hospital, Chieti, Italy.
| | | | - Claudio Simeone
- Department of Urology, "Spedali Civili" Hospital, Brescia, Italy.
| | - Andrea Tubaro
- Department of Urology, "Sant'Andrea" Hospital, University "La Sapienza", Rome, Italy.
| | - Cosimo de Nunzio
- Department of Urology, "Sant'Andrea" Hospital, University "La Sapienza", Rome, Italy.
| | - Luigi Schips
- Department of Urology, "S.Pio da Pietrelcina" Hospital, via San Camillo de Lellis, 1-66054, Vasto, Italy.
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Iweala EEJ, Ogidigo JO. Prostate Specific Antigen, Antioxidant and Hematological Parameters in Prostatic Rats Fed Solanum macrocarpon L. Leaves. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/ajbs.2015.30.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cindolo L, Pirozzi L, Fanizza C, Romero M, Tubaro A, Autorino R, De Nunzio C, Schips L. Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study. Eur Urol 2014; 68:418-25. [PMID: 25465970 DOI: 10.1016/j.eururo.2014.11.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/05/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about drug adherence in men treated for lower urinary tract symptoms (LUTS). Benign prostatic hyperplasia (BPH) is one of the causes of LUTS. OBJECTIVE To examine adherence to pharmacological therapy and its clinical value in men with LUTS. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study using an administrative prescription database and hospital discharge codes for 1.5 million men aged ≥40 yr treated with alpha blockers (ABs) and 5-alpha reductase inhibitors (5ARIs) alone or in combination (CT). INTERVENTIONS Therapy with ABs and/or 5ARIs. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The 1-yr and long-term adherence; hospitalization rates for BPH and BPH surgery. Multivariate Cox proportional hazards regression model, propensity score matching, and sensitivity analyses. RESULTS AND LIMITATIONS The 1-yr adherence was 29% in patients exposed to at least 6-mo therapy. Patients on CT had a higher discontinuation rate in the first 2 yr compared to those on monotherapy (p<0.0001). Overall hospitalization rates for BPH and BPH surgery were 9.04 and 12.6 per 1000 patient-years, respectively. A lower risk of hospitalization was observed for 5ARI compared to AB therapy (hazard ratio [HR] 0.46 and 0.23; p<0.0001). CT was associated with a reduced risk of hospitalization for BPH surgery (HR 0.94; p<0.0001) compared to AB. Discontinuation of drug treatment was an independent risk factor for hospitalization for BPH and BPH surgery (HR 1.65 and 2.80; p<0.0001) regardless of therapeutic group. Limitations include the paucity of clinical measures and the absence of patient-reported outcomes. CONCLUSIONS Adherence to pharmacological therapy for BPH is low and could affect clinical outcomes. Long-term 5ARI and CT use was associated with an independent reduced risk of hospitalization for BPH surgery. Our findings suggest the need for new strategies to increase patient adherence to prescribed treatment and more appropriate prescribing by physicians. PATIENT SUMMARY Our research shows that adherence to prescribed pharmacological therapy is crucial in the management of patients suffering from lower urinary tract symptoms. Moreover, pharmacological therapy can prevent disease progression.
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Affiliation(s)
- Luca Cindolo
- Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Italy.
| | - Luisella Pirozzi
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - Caterina Fanizza
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - Marilena Romero
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea, University La Sapienza, Rome, Italy
| | | | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, University La Sapienza, Rome, Italy
| | - Luigi Schips
- Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Italy
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Chen G, Liu H, Cheng F. Fangjihuangqi Tang improved lower urinary tract dysfunction in benign prostatic hyperplasia rats model. J TRADIT CHIN MED 2013; 33:349-54. [DOI: 10.1016/s0254-6272(13)60177-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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