The use of 5-alpha reductase inhibitors to manage benign prostatic hyperplasia and the risk of all-cause mortality

To compare the risk of mortality among men treated for benign prostatic hyperplasia (BPH) with 5?-reductase inhibitors (5ARI) to those treated with alpha-blockers (AB) in community practice settings.

We employed a retrospective matched cohort study in 4 regions of an integrated healthcare system. Men ages 50 years and older who initiated pharmaceutical treatment for BPH/LUTS between 1992 and 2008 and had at least 3 consecutive prescriptions were eligible and followed through 2010 (N=174,895). Adjusted hazard ratios (HR) were used to estimate the risk of mortality due to all-causes associated with 5?-reductase inhibitor use (with or without concomitant alpha-blockers) as compared to alpha-blocker use.

In this large and diverse sample with 543,523 person-years of follow-up, 35,266 men died during the study period, 18.9% of the 5ARI users and 20.4% of the AB users. After adjustment for age, medication initiation year, race, region, prior AB history, Charlson score and comorbidities, 5ARI use was not associated with an increased risk of mortality when compared to AB use (Adjusted HR: 0.64, 95% CI: 0.62, 0.66).

Among men receiving medications for BPH in community practice settings, 5?-reductase inhibitor use was not associated with an increased risk of mortality when compared to alpha-blocker use. These data provide reassurance about the safety of using 5ARIs in general practice to manage BPH/LUTS.

Urology. 2018 Jun 12 [Epub ahead of print]

Lauren P Wallner, Julia R DiBello, Bonnie H Li, Stephen K Van Den Eeden, Sheila Weinmann, Debra P Ritzwoller, Jill E Abell, Ralph D'Agostino, Ronald K Loo, David S Aaronson, Ralph I Horwitz, Steven J Jacobsen

Department of Medicine and Epidemiology, University of Michigan; Department of Research and Evaluation, Kaiser Permanente Southern California. Electronic address: ., Real World Evidence & Epidemiology, GlaxoSmithKline., Department of Research and Evaluation, Kaiser Permanente Southern California., Division of Research, Kaiser Permanente Northern California., Center for Health Research, Kaiser Permanente Northwest., Institute for Health Research, Kaiser Permanente Colorado., Real World Evidence, Janssen., Department of Biostatistical Science, Wake Forest University., Institute for Transformative Medicine, Temple University and Visiting Scholar, Institute of Medicine.

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