Long-term Combination Therapy With α-Blockers and 5α-Reductase Inhibitors in Benign Prostatic Hyperplasia: Patient Adherence and Causes of Withdrawal From Medication

Abstract

PurposeTo investigate long-term therapeutic effects and patient adherence to a combination therapy of a 5α-reductase inhibitor and an α-blocker and to identify causes of withdrawal from medication in patients with clinical benign prostatic hyperplasia (BPH).MethodsBPH patients with lower urinary tract symptoms (LUTS) receiving combination therapy with follow-ups for 1–12 years were retrospectively analyzed. Therapeutic effects were assessed at baseline and annually by measuring International Prostatic Symptoms Score, quality of life index, total prostate volume (TPV), maximal flow rate, voided volume, postvoid residual volume and prostate-specific antigen level. Causes of discontinued combination therapy were also investigated.ResultsA total of 625 patients, aged 40–97 years (mean, 73 years) were retrospectively analyzed. All measured parameters showed significant improvements after combination therapy. Three hundred sixty-nine patients (59%) discontinued combination therapy with a mean treatment duration of 2.2 years. The most common reasons for discontinued treatment were changing medication to monotherapy with α-blockers or antimuscarinics (124 patients, 19.8%), receiving surgical intervention (39 patients, 6.2%), and LUTS improvement (53 patients, 8.5%). Only 64 patients (10.2%) were loss to follow-up and 6 (1.0%) discontinued combined treatment due to adverse effects. Smaller TPV after short-term combination treatment caused withdrawal from combination therapy.ConclusionsBPH patients receiving long-term combination therapy showed significant improvement in all measured parameters. Changing medication, improved LUTS and choosing surgery are common reasons for discontinuing combination herapy. A smaller TPV after short-term combination treatment was among the factors that caused withdrawal from combination therapy.

Pharmacological and interventional treatment of benign prostatic obstruction: An evidence‐based comparative review

“… 11 Apart from lack of efficacy and adverse events, other common reasons affecting discontinuation of treatment include treatment regime change (19.8%), surgical intervention (6.2%), and improvement in BPO symptoms (8.5%). 49 Furthermore, with long‐term pharmacotherapy for BPO there are increasing reports of associations with neurocognitive decline, depression, and long‐term sexual dysfunction. 2 These factors all need to be considered when counseling men for pharmacological therapy.…”

“…Importantly, discontinuation was highest for the combination therapy and discontinuation was an independent risk factor for the hospitalization for BPO and BPO surgery (HR 1.65 & 2.80, P < .0001) 11 . Apart from lack of efficacy and adverse events, other common reasons affecting discontinuation of treatment include treatment regime change (19.8%), surgical intervention (6.2%), and improvement in BPO symptoms (8.5%) 49 . Furthermore, with long‐term pharmacotherapy for BPO there are increasing reports of associations with neurocognitive decline, depression, and long‐term sexual dysfunction 2 .…”

A prospective, randomized, open‐label, parallel trial comparing the efficacy of α‐blocker or 5α‐reductase inhibitor withdrawal to continued combination therapy on the maintenance of lower urinary tract symptoms in men with benign prostatic hyperplasia

“…3 While long-term combination therapy is generally well tolerated by most patients, the incidence of adverse events and medication expenditure with combination therapy is higher than with either therapy alone. 4,5 The adverse effects of ABs include orthostatic hypotension, dizziness, nasal congestion, and retrograde ejaculation in 3%-10% of patients, while 5ARIs cause erectile dysfunction, ejaculatory dysfunction, and decreased libido in 1%-8% of patients. 6 In the medical therapy of prostatic symptoms and combination of avodart and tamsulosin studies, the rates of these adverse events were higher with combination therapy compared with monotherapy.…”

Effect of Methanol Leaf Extract of Duranta erecta in Rats Induced with Benign Prostatic Hyperplasia

“…A good number of the individuals in developing nations depend mostly on herbal medicines for their medications. 9 These herbal medicines are cheaper and mostly with lesser side effects compared with synthesised medicines, hence, they could form better alternative sources for the management of BPH. Duranta erecta is a light green coloured plant which bears orange fruits.…”