Abstract
Objective
To compare the risk of mortality among men treated for benign prostatic hyperplasia
(BPH) with 5 alpha-reductase inhibitors (5ARI) to those treated with alpha-blockers
(AB) in community practice settings.
Methods
We employed a retrospective matched cohort study in 4 regions of an integrated healthcare
system. Men aged 50 years and older who initiated pharmaceutical treatment for BPH
and/or lower urinary tract symptoms between 1992 and 2008 and had at least 3 consecutive
prescriptions that were eligible and followed through 2010 (N = 174,895). Adjusted
hazard ratios were used to estimate the risk of mortality due to all-causes associated
with 5ARI use (with or without concomitant ABs) as compared to AB use.
Results
In this large and diverse sample with 543,523 person-years of follow-up, 35,266 men
died during the study period, 18.9% of the 5ARI users and 20.4% of the AB users. After
adjustment for age, medication initiation year, race, region, prior AB history, Charlson
score, and comorbidities, 5ARI use was not associated with an increased risk of mortality
when compared to AB use (Adjusted hazard ratios: 0.64, 95% confidence interval: 0.62,
0.66).
Conclusion
Among men receiving medications for BPH in community practice settings, 5ARI use was
not associated with an increased risk of mortality when compared to AB use. These
data provide reassurance about the safety of using 5ARIs in general practice to manage
BPH and/or lower urinary tract symptoms.
Keywords
Abbreviations:
5ARI (5 Alpha-reductase inhibitors), AB (alpha-blockers), BPH (benign prostatic hyperplasia), LUTS (lower urinary tract symptoms), HR (hazard ratio), KP (Kaiser Permanente), ED (erectile dysfunction), OAB (overactive bladder), PCPT (Prostate Cancer Prevention Trial)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 12, 2018
Accepted:
May 24,
2018
Received in revised form:
May 7,
2018
Received:
January 26,
2018
Footnotes
☆Conflict of Interest Disclosures: Drs. Wallner, Jacobsen, Abell, Van Den Eeden, D'Agsotino Jr., DiBello, Loo, and Horwitz report funding from GlaxoSmithKline for this study. Dr. Dibello is an employee of GlaxoSmithKline and reports stock holdings. Dr. Van Den Eeden report funding from Takeda not related to the topic of this study. Drs. Aaronson, Li, Weinmann, Ritzwoller, and Richert-Boe have no additional financial disclosures to report.
✯✯Funding: This study was supported by a research grant from GlaxoSmithKline.
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© 2018 Elsevier Inc. All rights reserved.
