Prevalence of urinary tract infections in women with vulvovaginal atrophy and the impact of vaginal prasterone on the rate of urinary tract infections

Abstract

Objective: The aims of this study were to assess the prevalence of urinary tract infections (UTI) in women newly diagnosed with vulvovaginal atrophy (VVA) versus women without VVA and to evaluate the potential of vaginal prasterone to be used in postmenopausal VVA women with UTI as prophylaxis to reduce the future UTI risk. As a first subgroup analysis, women using aromatase inhibitors, medications that stop the production of estrogen were analyzed. As a second subgroup analysis, we looked at women with diabetes to investigate whether the same prophylaxis approach should be considered.

Methods: This observational retrospective inception cohort study was conducted using the Integrated Dataverse open-source claims database with data from February 2015 through January 2020.

Results: A total of 22,245 women treated with prasterone for a minimum of 12 weeks were matched to women without any prescribed VVA-related treatment. Overall, women treated with prasterone have a significantly lower UTI prevalence compared to those untreated (6.58% vs 12.3%; P < 0.0001). The highest difference in UTI prevalence among the prasterone treated and untreated women was observed in those aged 65-74 (7.15% vs 16.2%; P < 0.0001). Among aromatase inhibitor users and women with diabetes, those treated with prasterone have a significantly lower UTI prevalence (4.90% vs 9.79%; P < 0.01 and 14.59% vs 20.48%; P < 0.0001, respectively).

Conclusions: This study suggests that intravaginal prasterone may be a good candidate for prophylaxis in postmenopausal women with UTI to reduce future UTI risk, including for women taking aromatase inhibitors and women with diabetes. This study is based on real-world evidence and warrants further investigation in a clinical setting.

FIG. 1

(A) Objective 1—attrition of women with and without VVA. Symphony's Integrated Dataverse: January 2, 2015 through January 31, 2020. ^aVVA treatments include prasterone, vaginal estrogens, or ospemifene. ^bFor women with VVA, the index date was defined as the first VVA diagnosis. ^cFor women without VVA, the index date was imputed based on a randomly selected outpatient visit. ^dVVA women were matched 1:1 to non-VVA women based on year of index date, age, region, and diabetes (assessed during the 365-day baseline period). (B) Objective 2—attrition of VVA women not receiving any VVA treatment and prasterone-treated VVA women. Symphony's Integrated Dataverse: January 2, 2015 through January 31, 2020. ^aThe date of the first dispensed prasterone is defined as the index date. For the untreated VVA cohort, the index date is defined as the first VVA diagnosis. ^bVVA treatments include prasterone, vaginal estrogens, or ospemifene. ^cPrasterone women were matched 1:1 to VVA women based on age, baseline diabetes, the number of urinary tract infection episodes (42-day gap) at the baseline, the use of aromatase inhibitors (overlap with index date–evidence of days of supply), and evidence of VVA treatment in the 12-month period preceding and including the index date. AI, aromatase inhibitors; VVA, vulvovaginal atrophy.

FIG. 2

(A) Objective 1—prevalence of UTI among women newly diagnosed with VVA and their controls during the observation period (n = 545,246). (B) Objective 1—relative risks (95% CI) of UTI in women newly diagnosed with VVA versus no VVA (n = 545,246). (C) Objective 1—prevalence of UTI among women newly diagnosed with VVA and their controls, during the observation period, by age and history of diabetes. UTI, urinary tract infection; VVA, vulvovaginal atrophy.

FIG. 3

(A) Objective 2—prevalence of UTI among VVA women not receiving any VVA treatment and VVA women treated with prasterone during the observation period (n = 22,245). (B) Objective 2—relative risks (95% CI) of UTI in VVA women not receiving any VVA treatment compared to VVA women treated with prasterone (n = 22,245). UTI, urinary tract infection; VVA, vulvovaginal atrophy.