title: Comparative analysis of alpha-blocker utilization in combination with 5-alpha reductase inhibitors for enlarged prostate in a managed care setting among Medicare-aged men.
abstract: OBJECTIVE
  To evaluate the likelihood of alpha-adrenergic antagonist (alpha-blocker) discontinuation in combination with dutasteride or finasteride among patients aged > or =65 years with enlarged prostate.
  
  
  METHODS
  This retrospective analysis used 2003-2006 data representing more than 30 million managed care members. Medical/pharmacy claims were used to select patients, matched 1:1 using propensity scoring. The proportion remaining on alpha-blocker therapy more than 12 months and time to discontinuation were compared between groups, controlling for covariates using survival analysis.
  
  
  RESULTS
  The matched sample included 1674 patients. Alpha-blocker therapy discontinuation was observed at 90 days (86.9% dutasteride patients and 91.8% finasteride patients remained on alpha-blocker therapy). After 12 months, more dutasteride patients discontinued (38.1% remained) alpha-blocker therapy than finasteride patients (56.3% remained).
  
  
  CONCLUSIONS
  Patients discontinued alpha-blocker therapy as early as 3 months. Those taking dutasteride were 64% more likely to discontinue alpha-blocker therapy than patients taking finasteride. Dutasteride's impact on discontinuation may have important implications and should be examined further.
authors.affiliation: Department of Urology, Emory University, 1670 Clairmont Rd, Decatur, GA 30033, USA. mmissa@aol.com
authors.forename: Muta M
authors.initials: MM
authors.lastname: Issa
authors.forename: Pei-Jung
authors.initials: PJ
authors.lastname: Lin
authors.forename: Michael T
authors.initials: MT
authors.lastname: Eaddy
authors.forename: Manan B
authors.initials: MB
authors.lastname: Shah
authors.forename: E Anne
authors.initials: EA
authors.lastname: Davis
mesh_terms: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001378:Azasteroids / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000068538:Dutasteride; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D018120:Finasteride / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D006278:Medicare; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000201:enzymology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists; D001378:Azasteroids; D004791:Enzyme Inhibitors; D018120:Finasteride; D000068538:Dutasteride