Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Population Health Data Center, National Cheng Kung University, Tainan, Taiwan.
Age Ageing. 2024 Jul 2;53(7). doi: 10.1093/ageing/afae155.
Recent studies suggest that 5α-reductase inhibitors (5ARIs) for benign prostate hyperplasia (BPH) result in abnormal retinal anatomical alteration.
To compare age-related macular degeneration (AMD) incidence in BPH patients receiving 5ARIs or tamsulosin.
Retrospective, population-based cohort study using new-user and active-comparator design.
General population.
Males with BPH, newly receiving 5ARIs or tamsulosin from 2010 to 2018.
Data were extracted from Taiwan's National Health Insurance Research Database. We used Cox proportional hazards model with 1:4 propensity score (PS) matching, based on intention-to-treat analysis to determine the risk of incident AMD. Sensitivity analyses included an as-treated approach and weighting-based PS methods. We also separately reported the risks of incident AMD in patients receiving finasteride and dutasteride to determine risk differences among different 5ARIs.
We included 13 586 5ARIs users (mean age: 69 years) and 54 344 tamsulosin users (mean age: 68.37 years). After a mean follow-up of 3.7 years, no differences were observed in the risk of incident AMD between 5ARIs and tamsulosin users [hazard ratio (HR): 1.06; 95% confidence intervals (95% CI): 0.98-1.15], with similar results from sensitivity analyses. However, increased risk of incident age-related macular degeneration was observed in patients receiving dutasteride [HR: 1.13; 95% CI: 1.02-1.25], but not in those receiving finasteride [HR: 0.99; 95% CI: 0.87-1.12], in the subgroup analyses.
We found no difference between 5ARIs and tamsulosin regarding the incidence of AMD in BPH patients. However, the risk profiles for AMD differed slightly between dutasteride and finasteride, suggesting that the potency of androgen inhibition is a factor related to AMD incidence.
最近的研究表明，5α-还原酶抑制剂（5ARIs）治疗良性前列腺增生（BPH）会导致视网膜解剖结构异常。
比较接受 5ARIs 或坦索罗辛治疗的 BPH 患者年龄相关性黄斑变性（AMD）的发病率。
使用新用户和活性对照设计的回顾性基于人群的队列研究。
普通人群。
2010 年至 2018 年新接受 5ARIs 或坦索罗辛治疗的 BPH 男性。
数据从台湾全民健康保险研究数据库中提取。我们使用 Cox 比例风险模型和 1:4 倾向评分（PS）匹配（基于意向治疗分析）来确定 AMD 的发病风险。敏感性分析包括治疗方法和基于权重的 PS 方法。我们还分别报告了接受非那雄胺和度他雄胺治疗的患者发生 AMD 的风险，以确定不同 5ARIs 之间的风险差异。
我们纳入了 13586 名 5ARIs 使用者（平均年龄：69 岁）和 54344 名坦索罗辛使用者（平均年龄：68.37 岁）。平均随访 3.7 年后，5ARIs 与坦索罗辛使用者之间 AMD 发病风险无差异[风险比（HR）：1.06；95%置信区间（95%CI）：0.98-1.15]，敏感性分析结果相似。然而，在亚组分析中，接受度他雄胺治疗的患者发生 AMD 的风险增加[HR：1.13；95%CI：1.02-1.25]，但接受非那雄胺治疗的患者[HR：0.99；95%CI：0.87-1.12]无差异。
我们发现 5ARIs 和坦索罗辛在 BPH 患者 AMD 发病率方面没有差异。然而，AMD 的风险特征在度他雄胺和非那雄胺之间略有不同，这表明雄激素抑制的效力是与 AMD 发病率相关的一个因素。
