Zabkowski T, Saracyn M
Urological Outpatient Clinic, Warsaw, Poland.
J Physiol Pharmacol. 2018 Aug;69(4). doi: 10.26402/jpp.2018.4.14. Epub 2018 Dec 9.
Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is one of the most common urinary disorders in elderly men. In recent years, pharmacotherapy of BPH has increased the efficacy, including combination treatment mostly with two drug classes, namely, 5-α-reductase inhibitors and α-1-adrenolytics (alpha blockers) with a different pharmacological activity. Although pharmacological treatment of BPH is a success story in urology, daily practice suggests that several medical needs remain unmet. We aimed to evaluate drug adherence in patients receiving pharmacological therapy to treat LUTS/BPH, and to analyze drug adherence among monotherapy and combination therapy. The sample population consisted of 758 men aged > 40 years who had been prescribed medications for LUTS/BPH during the index period between June 2015 and August 2016. Only alpha blockers and 5-α-reductase inhibitors (5ARIs) were considered in the analysis. Among ABs there were doxazosin, tamsulosin, alfuzosin, terazosin and among 5-α-reductase inhibitors it was only finasteride. Drug adherence was assessed in patients who were treated for a minimum of 6 months. Two levels of exposure were evaluated, follow-ups: ≥ 6 months, and ≥ 12 months. In patients who were treated for at least 6 months, the drug adherence rate was 32% and the 12-month drug adherence rate was 23%. We observed an inverse relationship between drug adherence rates and the duration of treatment - longer the duration of pharmacological therapy, lower was the drug adherence rate noted. Our study shows a low rate of overall drug adherence in patients diagnosed with BPH. It was observed that a low adherence rate is closely related to drug-related problems (DRP). Furthermore, this is a correlation between the degree of LUTS/BPH and adherence rate - the higher degree of LUTS/BPH, the higher adherence rate. Further studies are warranted focusing on assessing adherence to pharmacological therapy.
与良性前列腺增生（BPH）相关的下尿路症状（LUTS）是老年男性中最常见的泌尿系统疾病之一。近年来，BPH的药物治疗提高了疗效，包括大多使用两类药物的联合治疗，即具有不同药理活性的5-α还原酶抑制剂和α-1肾上腺素能阻滞剂（α受体阻滞剂）。尽管BPH的药物治疗在泌尿外科领域是一个成功案例，但日常实践表明仍有一些医疗需求未得到满足。我们旨在评估接受药物治疗以治疗LUTS/BPH的患者的药物依从性，并分析单药治疗和联合治疗中的药物依从性。样本人群包括758名年龄大于40岁的男性，他们在2015年6月至2016年8月的索引期内被开具了治疗LUTS/BPH的药物。分析中仅考虑α受体阻滞剂和5-α还原酶抑制剂（5ARIs）。在α受体阻滞剂中，有阿夫唑嗪、坦索罗辛、多沙唑嗪、特拉唑嗪，而在5-α还原酶抑制剂中只有非那雄胺。对接受至少6个月治疗的患者进行药物依从性评估。评估了两个暴露水平的随访情况：≥6个月和≥12个月。在接受至少6个月治疗的患者中，药物依从率为32%，12个月的药物依从率为23%。我们观察到药物依从率与治疗持续时间之间呈反比关系——药物治疗持续时间越长，观察到的药物依从率越低。我们的研究表明，被诊断为BPH的患者总体药物依从率较低。据观察，低依从率与药物相关问题（DRP）密切相关。此外，LUTS/BPH的程度与依从率之间存在相关性——LUTS/BPH程度越高，依从率越高。有必要开展进一步研究，重点评估药物治疗的依从性。
