Naslund Michael, Black Libby, Eaddy Michael, Batiste LaKeasha R
University of Maryland School of Medicine, Baltimore, MD 21201-1559, USA.
Am J Manag Care. 2007 Feb;13 Suppl 1:S17-22.
The objective of this study was to directly assess the likelihood and timing of alpha blocker discontinuation in patients receiving combination therapy with dutasteride or finasteride plus an alpha blocker.
A retrospective analysis of the PharMetrics Integrated Medical and Pharmaceutical Database (Watertown, Mass) was conducted to assess differences in alpha blocker discontinuation rates for patients initiated on 5-alpha reductase inhibitor (5ARI) therapy. The database is nationally representative, encompassing more than 45 million patients from 85 managed healthcare plans. Male patients aged >50 years with a diagnosis of enlarged prostate (EP) who were receiving alpha blocker therapy and who began 5ARI treatment (dutasteride or finasteride) between January 1, 1999, and March 1, 2005, were included. Patients were studied for up to 12 months to evaluate the likelihood and timing of alpha blocker discontinuation.
Overall, 56.7% of the patients remained on alpha blocker therapy for 6 months. At 1 year, more dutasteride patients had discontinued alpha blocker therapy (48.9% remained on alpha blocker) than finasteride patients (58.7% remained on alpha blocker). After controlling for background covariates, dutasteride patients were 19.9% more likely to discontinue alpha blocker therapy over 365 days.
Patients with EP who are taking an alpha blocker and 5ARI in combination for urinary symptom relief discontinue their alpha blocker 19.9% earlier when taking dutasteride than when taking finasteride. The ability to discontinue alpha blocker therapy earlier could reduce the costs of pharmacotherapy while continuing to provide an adequate level of symptom control and disease modification, which may result in cost savings to healthcare plans.
本研究的目的是直接评估接受度他雄胺或非那雄胺联合α受体阻滞剂治疗的患者停用α受体阻滞剂的可能性和时间。
对PharMetrics综合医学和药学数据库（马萨诸塞州沃特敦）进行回顾性分析，以评估开始接受5α还原酶抑制剂（5ARI）治疗的患者中α受体阻滞剂停药率的差异。该数据库具有全国代表性，涵盖来自85个管理式医疗保健计划的超过4500万患者。纳入年龄>50岁、诊断为前列腺增生（EP）、正在接受α受体阻滞剂治疗且在1999年1月1日至2005年3月1日期间开始5ARI治疗（度他雄胺或非那雄胺）的男性患者。对患者进行长达12个月的研究，以评估停用α受体阻滞剂的可能性和时间。
总体而言，56.7%的患者接受α受体阻滞剂治疗达6个月。在1年时，停用α受体阻滞剂治疗的度他雄胺患者（48.9%仍在接受α受体阻滞剂治疗）多于非那雄胺患者（58.7%仍在接受α受体阻滞剂治疗）。在控制背景协变量后，度他雄胺患者在365天内停用α受体阻滞剂治疗的可能性高出19.9%。
为缓解尿路症状而联合服用α受体阻滞剂和5ARI的EP患者，服用度他雄胺时停用α受体阻滞剂的时间比服用非那雄胺时早19.9%。更早停用α受体阻滞剂治疗的能力可以降低药物治疗成本，同时继续提供足够水平的症状控制和疾病改善，这可能会节省医疗保健计划的成本。
