PD33: Benign Prostatic Hyperplasia: Medical & Non-surgical Therapy
PD33-03: High real-world medication adherence and durable clinical benefit in Medicare patients prescribed 5 alpha-reductase inhibitors for benign prostatic hyperplasia related lower urinary tract symptoms
Introduction: Although clinical trials have demonstrated 5 alpha-reductase inhibitors (5ARIs) are efficacious treatments for benign prostatic hyperplasia (BPH), 5ARIs have low reported medication adherence outside the context of clinical trials. We aim to evaluate real-world drug adherence and long-term clinical outcomes in Medicare patients with lower urinary tract symptoms (LUTS) from BPH who were treated with 5ARI therapy.
Methods: We accessed healthcare claims and pharmacy records from Partners Healthcare Medicare Accountable Care Organization enrollees from January 2012 to December 2017. We identified individuals initiating a 5ARI for BPH with more than one medication dispensation. Adherence was calculated as proportion of days covered (PDC) =80%. The primary outcome of 5ARI treatment failure was defined as any BPH related surgery. A Cox proportional hazards model was used to estimate median time to surgical intervention in high adherence and low adherence patients.
Results: Among 3,107 men initiating 5ARI therapy for BPH related LUTS, 74.9% had high medication adherence over one year. Patients with low adherence had 29% higher hazards of undergoing surgical intervention (95% confidence interval [CI]: 1.02 to 1.59, p = 0.036) after adjusting for age, BPH severity, the presence of hematuria, bladder stones, and type of 5ARIs. The presence of bladder stones (hazard ratio [HR] = 1.70, 95% CI: 1.02 to 2.86, p = 0.04) and finasteride vs. dutasteride use (HR = 1.41, 95% CI: 1.01 to 1.98, p = 0.05) were also significant risk factors for surgical intervention.
Conclusions: Among Medicare patients, 5ARI treatment adherence was high (75%) and associated with persistently lower hazards of surgical intervention. 5ARI therapy may be more feasible for older men with BPH related LUTS than previously reported and demonstrates clinical benefit. Source of
