Persistence to Medications for Benign Prostatic Hyperplasia/Benign Prostatic Obstruction-Associated Lower Urinary Tract Symptoms in the ASL TO4 Regione Piemonte (Italy)

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.

Keywords: adherence; drug prescription networks; steroid 5α-reductase inhibitors; α1-adrenoceptor antagonists.

Figure 1

Persistence to treatment with ABs. (A) Kaplan-Meier curves of the time to discontinuation for specific drugs (alfuzosin, N = 584; doxazosin, N = 88; silodosin, N = 1074; tamsulosin, N = 2057; terazosin, N = 219); (B) Kaplan-Meier curves of the time to discontinuation for younger (<70 years of age, N = 1543) and older (≥70 years of age, N = 1730) men.

Figure 2

Persistence to treatment with 5ARIs. (A) Kaplan-Meier curves of the time to discontinuation for specific drugs (dutasteride, N = 1064; finasteride, N = 416); (B) Kaplan-Meier curves of the time to discontinuation for younger (<70 years of age, N = 420) and older (≥70 years of age, N = 987) men.

Figure 3

Prescription of drugs for the treatment of BPH/BPO-associated LUTS in the pre-specified age groups. (A) Distribution of men with respect to the number of pharmacological classes (Classes) prescribed; (B) Distribution of men with respect to the number of drugs (Drugs) prescribed; (C) Distribution of men with respect to the number of ABs (Drugs) prescribed; (D) Distribution of men with respect to the number of 5ARIs (Drugs) prescribed.