– Pukyung National University Department of Earth and Environmental Sciences, Republic of Korea
Background: While alpha-blocker (AB) and/or 5-alpha reductase inhibitor (5ARI) is recommended for long-term use to manage benign prostatic hyperplasia (BPH), there is a lack of data to understand the drug utilization pattern in the real world setting.
Objectives: To evaluate BPH treatment pattern (duration, switch and discontinuation) utilizing National Health Insurance Bigdata in South Korea
Methods: Claims data (2009-2019) was obtained from National Health Insurance Bigdata to establish a retrospective cohort. The study population was 40 years or older males with the first BPH diagnosis made between 2011 and 2013, who initiated AB or 5ARI within 30 days after the diagnosis. Included patients were classified into 5 groups as AB monotherapy, 5ARI monotherapy, AB and 5ARI dual therapy, two ABs dual therapy, and other combinations of AB and 5ARI drugs. We followed patients up to 6 years until discontinuation to look for a change in drug regimen from one to another group. Discontinuation was defined by no prescription record for 90 days after the last date that the last prescription covered. We calculated “treatment duration” by the sum of days covered by individual prescriptions until discontinuation. Resumption was defined by the presence of a prescription record qualifying an inclusion for any of the 5 drug groups after discontinuation. For the patients who had treatment switched at least once, we analyzed the distribution of drug groups before and after the switch.
Results: A total of 460,895 patients with a mean age of 62.1 were included in the analysis. The most prevalent drug regimen as the initial therapy was AB monotherapy (N=290,569; 63.0%) followed by AB and 5ARI dual therapy (N=114,009; 24.7%), and 5ARI monotherapy (N=43,560; 9.5%). Most patients in the 5ARI monotherapy continued the initial treatment without switching (N=34,903; 80.13%) but the mean treatment duration was the lowest (116.3±239.5days) among the 3 prevalent drug regimens. The mean treatment duration was 298.3 for AB monotherapy and 336.6 days for AB and 5ARI dual therapy. The treatment duration tended to increase as the number of switch increased, regardless of the initial treatment type. For patients who switched drug regimens, AB monotherapy or AB and 5ARI dual therapy were the two most prevalent regimens which patients switched to, indicating patients continued to use AB intermittently with or without 5ARI throughout BPH management. The overall resumption rate was 43.1%.
Conclusions: The results suggest that patients tend to utilize AB with or without 5ARI predominantly and intermittently. The clinical consequences of early discontinuation or intermittent use of the first line BPH drugs should be investigated in future research to optimize BPH management in the real world.
