Kim Jae Heon, Shim Sung Ryul, Khandwala Yash, Del Giudice Francesco, Sorensen Simon, Chung Benjamin I
Department of Urology, Stanford University Medical Center, Stanford, CA, USA.
Department of Urology, Soonchunhyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea.
World J Mens Health. 2020 Oct;38(4):535-544. doi: 10.5534/wjmh.190046. Epub 2019 May 23.
Although five-alpha reductase inhibitor (5-ARI) is one of standard treatment for benign prostatic hyperplasia (BPH) or alopecia, potential complications after 5-ARI have been issues recently. This study aimed to investigate the risk of depression after taking 5-ARI and to quantify the risk using meta-analysis.
A total of 209,940 patients including 207,798 in 5-ARI treatment groups and 110,118 in control groups from five studies were included for final analysis. Inclusion criteria for finial analysis incudes clinical outcomes regarding depression risk in BPH or alopecia patients. Overall hazard ratio (HR) and odds ratio (OR) for depression were analyzed. Moderator analysis and sensitivity analysis were performed to determine whether HR or OR could be affected by any variables, including number of patients, age, study type, and control type.
The pooled overall HRs for the 5-ARI medication was 1.23 (95% confidence interval [CI], 0.99-1.54) in a random effects model. The pooled overall ORs for the 5-ARI medication was 1.19 (95% CI, 0.95-1.49) in random effects model. The sub-group analysis showed that non-cohort studies had higher values of HR and OR than cohort studies. Moderator analysis using meta-regression showed that there were no variables that affect the significant difference in HR and OR outcomes. However, in sensitivity analysis, HR was significantly increased by age (p=0.040).
Overall risk of depression after 5-ARI was significantly not high, however its clinical importance needs validation by further studies. These quantitative results could provide useful information for both clinicians and patients.
尽管5α还原酶抑制剂（5-ARI）是良性前列腺增生（BPH）或脱发的标准治疗方法之一，但5-ARI治疗后的潜在并发症近来一直备受关注。本研究旨在调查服用5-ARI后发生抑郁症的风险，并通过荟萃分析对该风险进行量化。
最终分析纳入了五项研究中的总共209,940名患者，其中5-ARI治疗组有207,798名，对照组有110,118名。最终分析的纳入标准包括BPH或脱发患者抑郁症风险的临床结局。分析了抑郁症的总体风险比（HR）和优势比（OR）。进行了调节分析和敏感性分析，以确定HR或OR是否会受到任何变量的影响，这些变量包括患者数量、年龄、研究类型和对照类型。
在随机效应模型中，5-ARI药物治疗的合并总体HR为1.23（95%置信区间[CI]，0.99-1.54）。在随机效应模型中，5-ARI药物治疗的合并总体OR为1.19（95%CI，0.95-1.49）。亚组分析显示，非队列研究的HR和OR值高于队列研究。使用元回归的调节分析表明，没有变量会影响HR和OR结果的显著差异。然而，在敏感性分析中，HR随年龄显著增加（p=0.040）。
5-ARI治疗后抑郁症的总体风险显著不高，但其临床重要性需要进一步研究验证。这些定量结果可为临床医生和患者提供有用信息。
