Drug treatment patterns for the management of men with lower urinary tract symptoms associated with benign prostatic hyperplasia who have both storage and voiding symptoms: a study using the health improvement network UK primary care data

Curr Med Res Opin. 2015 Jan;31(1):43-50. doi: 10.1185/03007995.2014.968704. Epub 2014 Oct 28.

Abstract

Background: Real-world data on the pharmacological management of men who have lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are limited.

Objective: To characterize men with LUTS/BPH who had both storage and voiding symptoms and to evaluate treatment patterns in UK primary care.

Design, setting and participants: This was an observational study of men aged ≥45 years with a diagnosis, symptoms or therapies indicative of LUTS/BPH with both storage and voiding components. These men were identified from the large Health Improvement Network (THIN) database between 1 January 2004 and 30 September 2011.

Outcome measurements and statistical analysis: Drug prescriptions and switching/discontinuation patterns for α₁-blockers and antimuscarinics.

Results and limitations: We identified 8694 men with a median age of 66.0 (interquartile range [IQR], 59.0-74.0) years. Most (7850; 90.3%) received an α₁-blocker, and 2167 (24.9%) received antimuscarinic therapy over a median of 2.1 years. The most commonly prescribed α₁-blocker was tamsulosin (81.8%); most frequent antimuscarinics were tolterodine (41.0%), oxybutynin (37.2%) and solifenacin (35.7%). Concomitant prescription of α1-blocker and antimuscarinic therapy (within 30 days of each other) was received by 1160 men (14.8% of α₁-blocker-treated men). Of α₁-blocker recipients, 3024 (38.5%) discontinued during follow-up, while 1149 (53.0%) discontinued antimuscarinic therapy. Of 2167 men who received an antimuscarinic, 476 (22.0%) switched to another antimuscarinic. Of the three most commonly prescribed antimuscarinics, solifenacin had the lowest proportions of discontinuations (43.0%) and switches (15.3%), and the longest median duration of therapy (90 days, IQR 30-300). General practice consultations accounted for most resource use (5307.9 per 1000 patient-years).

Conclusions: This study presents real-world management of men with LUTS/BPH who have both storage and voiding symptoms. The low proportion of men who received concomitant α₁-blocker and antimuscarinic therapy suggests that some patients are sub-optimally treated in routine clinical practice.

Keywords: Adrenergic α1-receptor antagonists; Benign prostatic hyperplasia; Disease management; Health resources; Lower urinary tract symptoms; Muscarinic antagonists; Persistence; Storage symptoms.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic alpha-1 Receptor Antagonists / therapeutic use*
  • Aged
  • Benzhydryl Compounds / therapeutic use
  • Cresols / therapeutic use
  • Family Practice
  • Humans
  • Lower Urinary Tract Symptoms / drug therapy*
  • Lower Urinary Tract Symptoms / etiology*
  • Male
  • Mandelic Acids / therapeutic use
  • Middle Aged
  • Muscarinic Antagonists / therapeutic use*
  • Phenylpropanolamine / therapeutic use
  • Primary Health Care*
  • Prostatic Hyperplasia / complications*
  • Prostatic Hyperplasia / drug therapy
  • Quinuclidines / therapeutic use
  • Retrospective Studies
  • Solifenacin Succinate
  • Sulfonamides / therapeutic use
  • Tamsulosin
  • Tetrahydroisoquinolines / therapeutic use
  • Tolterodine Tartrate
  • United Kingdom

Substances

  • Adrenergic alpha-1 Receptor Antagonists
  • Benzhydryl Compounds
  • Cresols
  • Mandelic Acids
  • Muscarinic Antagonists
  • Quinuclidines
  • Sulfonamides
  • Tetrahydroisoquinolines
  • Phenylpropanolamine
  • Tolterodine Tartrate
  • Tamsulosin
  • oxybutynin
  • Solifenacin Succinate