Department of Urology, Medical Research Institute, Pusan National University Hospital, Pusan, Korea.
Department of Urology, Yangsan Pusan National University Hospital, Yangsan, Korea.
Urology. 2014 Aug;84(2):427-32. doi: 10.1016/j.urology.2014.02.068. Epub 2014 Jun 25.
To investigate the reasons for prescription change of α1-blockers in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.
The ratio and interval of prescription change were assessed in 3200 patients who were eligible for the study and took 1 of 4 different α1-blockers (doxazosin, alfuzosin, tamsulosin, or silodosin). The reasons for prescription change and evaluation of efficacy were analyzed in 444 patients whose medical records were complete.
Prescription change to another α1-blocker occurred in 694 of 3200 patients (21.7%), and the mean duration of taking their first α1-blocker was 10.8 ± 8.2 weeks. Lack of efficacy (52.7%) was the main reason for changing α1-blockers, followed by adverse events (33.1%), relatively high cost compared with other α1-blockers (7.0%), inconvenience of taking drugs (4.1%), and cardiovascular comorbidity (3.2%). The mean duration of treatment according to each reason is as follows: increased adverse events: 6.3 ± 5.2 weeks, relatively high cost compared with other α1-blockers: 8.7 ± 4.5 weeks, cardiovascular comorbidity: 10.5 ± 6.8 weeks, inconvenience of taking drugs: 10.8 ± 3.9 weeks, and lack of efficacy: 14.8 ± 6.8 weeks. The proportion of prescription change (16.3%) and prescription change because of hemodynamic adverse events (2.4%) in the silodosin group were low compared with those in the other groups (P <.05 and P <.006, respectively), but prescription change because of a ejaculation disorder was high in the silodosin group (30.1%, P <.001).
Major reasons for prescription change in patients taking α1-blockers were lack of efficacy and adverse events. In the silodosin group, the proportion of prescription change was significantly low compared with that in the other 3 groups.
探讨下尿路症状提示良性前列腺增生患者α1-受体阻滞剂处方改变的原因。
对符合条件且服用 4 种不同 α1-受体阻滞剂（多沙唑嗪、阿夫唑嗪、坦索罗辛或西洛多辛）之一的 3200 例患者评估了处方改变的比例和间隔。对病历完整的 444 例患者分析了处方改变的原因和疗效评估。
3200 例患者中有 694 例（21.7%）改用了另一种 α1-受体阻滞剂，服用首种 α1-受体阻滞剂的平均时间为 10.8 ± 8.2 周。疗效不佳（52.7%）是改变 α1-受体阻滞剂的主要原因，其次是不良事件（33.1%）、与其他 α1-受体阻滞剂相比相对较高的成本（7.0%）、药物服用不便（4.1%）和心血管合并症（3.2%）。根据每个原因的平均治疗时间如下：不良事件增加：6.3 ± 5.2 周，与其他 α1-受体阻滞剂相比成本较高：8.7 ± 4.5 周，心血管合并症：10.5 ± 6.8 周，药物服用不便：10.8 ± 3.9 周，疗效不佳：14.8 ± 6.8 周。与其他组相比，西洛多辛组的处方改变比例（16.3%）和因血液动力学不良事件的处方改变比例（2.4%）较低（P<.05 和 P<.006），但因射精障碍而改变处方的比例较高（30.1%，P<.001）。
服用 α1-受体阻滞剂的患者处方改变的主要原因是疗效不佳和不良事件。与其他 3 组相比，西洛多辛组的处方改变比例明显较低。
