High Real-World Medication Adherence and Durable Clinical Benefit in Medicare Patients Treated with 5-Alpha Reductase Inhibitors for Benign Prostatic Hyperplasia.
High Real-World Medication Adherence and Durable Clinical Benefit in Medicare Patients Treated with 5-Alpha Reductase Inhibitors for Benign Prostatic Hyperplasia.
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DOI：
10.1097/ju.0000000000001014
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发表时间：
2020-08
期刊：
影响因子：
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通讯作者：
Olumi AF
中科院分区：
文献类型：
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作者：
Zhang H;Frendl DM;Wang Z;Olumi AF
用5 α-还原酶抑制剂（5ARI）治疗良性前列腺增生（BPH）与药物依从性低相关。虽然研究已经评估了5ARI治疗对前列腺体积长期减少和前列腺手术需求的影响，但由于与临床试验相比，现实世界中的依从性较低，因此这些结果可能无法外推到现实世界。本研究的目的是评价在现实环境中接受5ARI治疗良性前列腺增生相关下尿路症状的患者的药物依从性和长期临床结局。我们访问了2009年1月至2018年7月合作伙伴医疗保健系统的纵向药房付款索赔记录。我们确定了个人与一个以上的分配5ARI诊断BPH和下尿路症状。使用覆盖天数比例（PDC）计算依从性。我们收集了自5ARI开始后第一年的人口统计学和临床变量。该研究的结果是5例ARI治疗失败，定义为BPH相关手术的发生。采用考克斯比例风险模型估计高依从性和低依从性患者的手术干预中位时间。在调整年龄、BPH分期、血尿、膀胱结石和5ARI类型后，对5ARI依从性低的患者更可能需要手术干预（95%置信区间[CI]：1.02 - 1.59，p = 0.036）。膀胱结石的存在（风险比[HR] = 1.70，95%CI：1.02至2.86，p = 0.043）和使用非那雄胺（HR = 1.41，95%CI：1.01至1.98，p = 0.050）是手术干预的重要风险因素。BPH患者对5ARI治疗的依从性低与患者预后差相关。因此，需要采取干预策略，以增加患者诊断后对5ARI治疗的依从性。
Treatment of benign prostatic hyperplasia (BPH) with 5 alpha-reductase inhibitors (5ARIs) is associated with low adherence to medication. Although studies have evaluated the impact of 5ARI therapy on long-term reduction in prostate volume and the need for prostate surgery, these results may not be extrapolated to the real-world due to lower adherence in the real-world compared to a clinical trial. The aim of this study was to evaluate drug adherence and long-term clinical outcomes in patients treated with 5ARIs therapy for lower urinary tract symptoms related to benign prostatic hyperplasia in a real-world setting. We accessed longitudinal, pharmacy payment claim records from the Partners Healthcare System from January 2009 to July 2018. We identified individuals with more than one dispensation of 5ARIs for diagnosis of BPH and lower urinary tract symptoms. Adherence was calculated using proportion of days covered (PDC). We collected demographic and clinical variables during the first year since the initiation of 5ARIs. The outcome of the study was 5ARIs treatment failure defined by the occurrence of a BPH related surgery. A Cox proportional hazards model was used to estimate median time to surgical intervention in high adherent and low adherent patients. Patients with low level of adherence to 5ARIs were more likely to need surgical intervention (95% confidence interval [CI]: 1.02 to 1.59, p = 0.036) after adjusting for age, BPH stage, the presence of hematuria, bladder stone, and type of 5ARIs. The presence of bladder stones (hazard ratio [HR] = 1.70, 95% CI: 1.02 to 2.86, p = 0.043) and finasteride use (HR = 1.41, 95% CI: 1.01 to 1.98, p = 0.050) were significant risk factors for surgical intervention. Low level of adherence to 5ARIs treatment in patients with BPH is associated with poor patient outcomes. Therefore, intervention strategies are needed to increase adherence to 5ARIs treatment after patients’ diagnosis.