In a recently published paper in BMC Urology journal entitled “Patient’s adherence on pharmacological therapy for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) is different: is combination therapy better than monotherapy?“, researchers from S.Pio da Pietrelcina Hospital in Italy, evaluated the magnitude of adherence to several drug classes including mono versus combination therapy as well as long term discontinuation of treatment in patients suffering from benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS).
Benign prostatic hyperplasia is a condition where prostate size increases as men age. In the US it is estimated that approximately 6% of the population suffers from the condition, with most experts believing that testosterone and related hormones play key roles in BPH development. As the prostate volume increases, primary clinical manifestations of BPH include LUTS with symptoms of pain and increased frequency of urination. The statistics show that LUTS increases from 22% among 50–59 year-old men to 45% for those older than 70 years. Nevertheless, only about 19% of patients with BPH-associated LUTS seek medical treatment and only 10.2% receive a treatment.
Pharmacological therapy for BPH-associated LUTS seeks to improve patient quality of life by relieving urinary symptoms as well as preventing complications like infections that could lead to renal failure at advanced stages. There are five classes of medications prescribed for patients with BPH-associated LUTS: alpha blockers (AB), 5-alpha reductase inhibitors (5ARI), phosphodiesterase-5 (PDE-5) inhibitors, antimuscarinics/beta3 agonists, and phytotherapeutics. On the other hand, combination therapy (CT) with ABs and 5ARIs is believed to be beneficial in controlling the symptoms as well as disease progression.
It has been reported that non-adherence of patients with BPH-associated LUTS to their medications increases the risk of disease progression. In this study, researchers performed a retrospective population study based on record-linkage analysis from databases like drug prescriptions database, civil registry and hospital discharge records on over 6.5 million subjects across 22 local Italian Health Authorities.
After selection, a total of 1.5 million Italian men over 40 of age treated with alpha-blockers (AB) and 5alpha-reductase inhibitors (5ARIs) alone or in combination (CT) for BPH-associated LUTS were analyzed. Standard mathematical and statistical test models were utilized for analysis of data recorded for 1-year and long term adherence together with analyses of hospitalization rates for BPH and BPH-related surgery. The results illustrated that patients who received therapy for at least 6 months displayed 1-year overall adherence of 29%. At the fifth year of follow up, it was noticed that patient’s adherence decreased progressively to 15%, 8% and 3% for AB, 5ARI, and CT, respectively. Furthermore, data suggested that when compared to those under monotherapy with ABs or 5ARIs, patients on CT registered higher discontinuation rates along all the follow-ups. As a consequence, CT was linked with a reduced risk of hospitalization for BPH-related surgery when compared to AB monotherapy patients.
In summary, these findings suggest that adherence to pharmacological therapy of BPH-associated LUTS is generally weak and drug class dependent. The demand for combining two medications for treatment of BPH is considered an obstacle in reaching better adherence. The statistics revealed that patients treated with CT have elevated tendency to interrupt their treatment. In order to prevent disease progression in BPH-associated LUTS patients new strategies that can boost adherence to the prescribed treatments are required. Also, the reasons for which patients decide to discontinue their therapy like in many observed CT cases should be investigated.