Dataset Information

A retrospective study of treatment persistence and adherence to ?-blocker plus antimuscarinic combination therapies, in men with LUTS/BPH in the Netherlands.

ABSTRACT: BACKGROUND:To assess treatment persistence and adherence in men ?45 years of age with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), using prescription records from the Netherlands IMS Lifelink™ LRx database. METHODS:In this retrospective, observational cohort study, we identified men who received combination therapy with an ?-blocker plus an antimuscarinic (e.g. solifenacin or tolterodine) between 1 November 2013 and 31 October 2014. Treatment could be received as a fixed-dose combination (FDC) tablet or as two drugs administered together (concomitant therapy), if both combination drugs were prescribed within 30 days. The primary objective was to assess treatment persistence, defined as the time from initiation of combination therapy until first discontinuation of the FDC or at least one of the drugs given concomitantly (i.e. ?30 days without prescription renewal). Subgroup and sensitivity analyses were conducted to assess persistence by antimuscarinic agent, and with different gap lengths used to define discontinuation (45, 60 and 90 days), respectively. RESULTS:A total of 1891 men received an ?-blocker plus an antimuscarinic (FDC, N = 665; concomitant therapy, N = 1226). Median time to discontinuation was significantly longer with FDC versus concomitant therapy (414 vs. 112 days; adjusted hazard ratio [HR] 2.04, 95% confidence interval 1.77, 2.35; p < 0.0001). Persistence at 12 months (51.3% vs. 29.9%) was also significantly greater with FDC compared with concomitant therapy. Assessment of antimuscarinic subgroups showed that median time to discontinuation was longest with solifenacin combinations (214 days) compared with other antimuscarinic combinations (range, 47-164 days; adjusted HR range, 1.27-1.77, p = 0.037). No observable impact on treatment persistence was found by adjusting the gaps used to define discontinuation. DISCUSSION:This study of real-world evidence of men with LUTS/BPH treated with ?-blocker plus antimuscarinic combination therapy in the Netherlands showed that treatment persistence was significantly greater in those who received a FDC tablet compared with combination therapy given concomitantly. The study also shows that treatment persistence was extended in men who received combination therapy containing solifenacin compared with other antimuscarinics. CONCLUSIONS:Overall, these findings may be useful for prescribers, as improved persistence on-treatment may translate into improved outcomes for men with LUTS/BPH. Further study is warranted to establish the key drivers of persistence in men receiving combination therapy for LUTS/BPH.

SUBMITTER: Drake MJ

PROVIDER: S-EPMC5440896 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A retrospective study of treatment persistence and adherence to α-blocker plus antimuscarinic combination therapies, in men with LUTS/BPH in the Netherlands.

Drake Marcus J MJ Bowditch Sally S Arbe Emilio E Hakimi Zalmai Z Guelfucci Florent F Amri Ikbel I Nazir Jameel J

BMC urology 20170522 1

<h4>Background</h4>To assess treatment persistence and adherence in men ≥45 years of age with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), using prescription records from the Netherlands IMS Lifelink™ LRx database.<h4>Methods</h4>In this retrospective, observational cohort study, we identified men who received combination therapy with an α-blocker plus an antimuscarinic (e.g. solifenacin or tolterodine) between 1 November 2013 and 31 October 2014. Treat ...[more]

PMID: 28532455

Similar Datasets

Project description:ObjectiveIdentifying biomarkers of prostatic inflammation has been a question of great interest in the development of anti-inflammatory pharmacotherapy for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Systemic inflammation and serum prostate-specific antigen (PSA) have been linked with prostatic inflammation. This study set out to develop a diagnostic model for prostatic inflammation using clinical and laboratory parameters.MethodsWe included LUTS/BPH patients undergoing transurethral resection of the prostate. The severity of prostatic inflammation was determined by pathological review. Clinical manifestations and preoperative laboratory test results were recorded. We used LASSO regression with 10-fold cross-validation to select variables with the most diagnostic value of prostatic inflammation. Furthermore, we used multivariable logistic regression analysis to develop the diagnostic model, presented in a nomogram. The discrimination, calibration of the post-LASSO diagnostic model, and the model supplemented with clinical parameters were assessed. Decision curve analysis was performed.ResultsA total of 164 patients were included. Of all patients, 97 (59.1%) had no or mild prostatic inflammation, and 67 (40.9%) had moderate to severe prostatic inflammation. A higher peripheral white blood cell count, higher peripheral lymphocyte count, lower free/total (f/t) PSA ratio, and acute urinary retention history were associated with a higher risk of moderate to severe prostatic inflammation. Peripheral lymphocyte count and f/t PSA ratio were selected by the LASSO method and entered into the nomogram. The post-LASSO diagnostic model had an AUC of 0.756 (95% CI: 0.684-0.829) and good calibration. The addition of clinical parameters failed to show incremental diagnostic value. The decision curve analysis demonstrated that the post-LASSO laboratory nomogram was clinically useful.ConclusionOur findings demonstrated that peripheral lymphocyte count and f/t PSA ratio appear to be reliable diagnostic markers, based on which we build a clinically useful nomogram for prostatic inflammation. This diagnostic model could facilitate the development of anti-inflammatory pharmacotherapy for LUTS/BPH. Before this model is adopted in clinical practice, future validation is needed to determine its clinical utility.

Dataset Information

A retrospective study of treatment persistence and adherence to ?-blocker plus antimuscarinic combination therapies, in men with LUTS/BPH in the Netherlands.

Publications

A retrospective study of treatment persistence and adherence to α-blocker plus antimuscarinic combination therapies, in men with LUTS/BPH in the Netherlands.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets