Trends in the pharmacological treatment of benign prostatic hyperplasia in the UK from 1998 to 2016: a population-based
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ORIGINAL ARTICLE
Trends in the pharmacological treatment of benign prostatic hyperplasia in the UK from 1998 to 2016: a population‑based cohort study Henok Tadesse Ayele1,2 · Pauline Reynier2 · Laurent Azoulay1,2,3 · Robert W. Platt1,2,4 · Josselin Cabaussel2 · Serge Benayoun5 · Kristian B. Filion1,2,6 Received: 5 December 2019 / Accepted: 30 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To describe trends in the pharmacological treatment of BPH in the United Kingdom (UK) from 1998 to 2016. Methods We created a cohort of men with a diagnosis of BPH between 1998 and 2016 using the Clinical Practice Research Datalink. Using Poisson regression, we estimated annual prescription rates of 5αRIs, α-blockers, and combination therapy (5αRIs + α-blockers). Adherence was defined by a proportion of days covered > 80%. Results Our cohort included 192,640 men with BPH who generated 1,176,264 person-years (PYs) of follow-up. The mean age was 68.0 (standard deviation: 10.7) years. The prescription rate of all BPH medications during the study period was 347.6 per 100 PYs (95% CI 347.2–347.9). α-Blockers had the highest prescription rate (222.9 per 100 PYs, 95% CI 222.7– 223.2); prescription rates of 5αRIs and combination therapy were 69.1 per 100 PYs (95% CI 69.0–69.3) and 55.5 per 100 PYs (95% CI 55.4–55.7), respectively. The prescription rate for combination therapy was 19 times greater in 2013–2016 than in 1998–2000 (rate ratio: 19.2, 95% CI 18.6–19.7), while the prescription rates for 5αRIs and α-blockers each doubled during this period (rate ratio: 1.86, 95% CI 1.84–1.88 and rate ratio: 2.02, 95% CI 2.01–2.04, respectively). The proportion of patients who were adherent at 1 year to 5αRIs (32.3%), α-blockers (44.0%), and combination therapy (45.6%) was low. Conclusion The prescription rate of BPH medications increased substantially between 1998 and 2016 in the UK, with the greatest relative increase observed with combination therapy. Adherence to BPH medications was low in this populationbased study. Keywords Five-alpha reductase inhibitors · Drug utilization · Pharmacoepidemiology · Benign prostatic hyperplasia · Alpha-blockers
Background
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03429-z) contains supplementary material, which is available to authorized users. * Kristian B. Filion [email protected] 1
Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montréal, Canada
2
Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada
3
Gerald Bronfman Department of Oncology, McGill University, Montréal, Canada
Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a condition affecting middle-aged and older men and is characterized by an enlarged prostate that restricts the normal flow of urine through the urethra 4
Department of Pediatrics, McGill University, Montréal, Canada
5
D
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