Pharmacotherapy for BPH-related LUTS: associations between medication patterns, persistence, and treatment failure

To evaluate real-world medical treatment profiles and the impact of prescription patterns on treatment persistence and failure in men with benign prostatic hyperplasia through a retrospective chart review.

We reviewed the medical charts of 779 patients who initiated pharmacotherapy with α-blockers (ABs), 5α-reductase inhibitors (5ARIs), or phosphodiesterase-5 inhibitors (PDE5Is) between January 2014 and December 2021. Baseline characteristics, prescription patterns, and the addition of antimuscarinics or β3-agonists were assessed via multivariable Cox proportional hazards models for the impact of these variables on treatment persistence, development of acute urinary retention (AUR), and progression to surgery. Missing baseline values were addressed via multiple imputation.

The median treatment duration was 29 months. Most patients (76%) initiated AB monotherapy, followed by AB plus 5ARI (6.5%) and AB plus antimuscarinics (5.5%). Forty-one men developed AUR, and 68 required surgery. 5ARI use and PDE5I use were associated with greater, whereas initial presentation with AUR (iAUR) was associated with lower treatment persistence. 5ARI use reduced AUR risk, whereas prostate enlargement increased the likelihood of AUR. Progression to surgery was associated with larger prostate volume, postvoid residual volume > 100 mL, and iAUR.

Despite their limited use, 5ARIs, PDE5Is, antimuscarinics, and β3-agonists were associated with longer treatment persistence. Additionally, 5ARIs were associated with a significant reduction in AUR risk.