title: Drug treatment patterns for the management of men with lower urinary tract symptoms associated with benign prostatic hyperplasia who have both storage and voiding symptoms: a study using the health improvement network UK primary care data.
abstract: BACKGROUND
  Real-world data on the pharmacological management of men who have lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are limited.
  
  
  OBJECTIVE
  To characterize men with LUTS/BPH who had both storage and voiding symptoms and to evaluate treatment patterns in UK primary care.
  
  
  METHODS
  This was an observational study of men aged ≥45 years with a diagnosis, symptoms or therapies indicative of LUTS/BPH with both storage and voiding components. These men were identified from the large Health Improvement Network (THIN) database between 1 January 2004 and 30 September 2011.
  
  
  METHODS
  Drug prescriptions and switching/discontinuation patterns for α₁-blockers and antimuscarinics.
  
  
  CONCLUSIONS
  We identified 8694 men with a median age of 66.0 (interquartile range [IQR], 59.0-74.0) years. Most (7850; 90.3%) received an α₁-blocker, and 2167 (24.9%) received antimuscarinic therapy over a median of 2.1 years. The most commonly prescribed α₁-blocker was tamsulosin (81.8%); most frequent antimuscarinics were tolterodine (41.0%), oxybutynin (37.2%) and solifenacin (35.7%). Concomitant prescription of α1-blocker and antimuscarinic therapy (within 30 days of each other) was received by 1160 men (14.8% of α₁-blocker-treated men). Of α₁-blocker recipients, 3024 (38.5%) discontinued during follow-up, while 1149 (53.0%) discontinued antimuscarinic therapy. Of 2167 men who received an antimuscarinic, 476 (22.0%) switched to another antimuscarinic. Of the three most commonly prescribed antimuscarinics, solifenacin had the lowest proportions of discontinuations (43.0%) and switches (15.3%), and the longest median duration of therapy (90 days, IQR 30-300). General practice consultations accounted for most resource use (5307.9 per 1000 patient-years).
  
  
  CONCLUSIONS
  This study presents real-world management of men with LUTS/BPH who have both storage and voiding symptoms. The low proportion of men who received concomitant α₁-blocker and antimuscarinic therapy suggests that some patients are sub-optimally treated in routine clinical practice.
authors.affiliation: Astellas Pharma Global Development , Leiden , Netherlands.
authors.forename: Zalmai
authors.initials: Z
authors.lastname: Hakimi
authors.forename: Michelle
authors.initials: M
authors.lastname: Johnson
authors.forename: Jameel
authors.initials: J
authors.lastname: Nazir
authors.forename: Betina
authors.initials: B
authors.lastname: Blak
authors.forename: Isaac A O
authors.initials: IA
authors.lastname: Odeyemi
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D000368:Aged; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D003408:Cresols / Q000627:therapeutic use; D005194:Family Practice; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D010665:Phenylpropanolamine / Q000627:therapeutic use; D011320:Primary Health Care; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000188:drug therapy; D011812:Quinuclidines / Q000627:therapeutic use; D012189:Retrospective Studies; D000069464:Solifenacin Succinate; D013449:Sulfonamides / Q000627:therapeutic use; D000077409:Tamsulosin; D044005:Tetrahydroisoquinolines / Q000627:therapeutic use; D000068737:Tolterodine Tartrate; D006113:United Kingdom
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D001559:Benzhydryl Compounds; D003408:Cresols; D008333:Mandelic Acids; D018727:Muscarinic Antagonists; D011812:Quinuclidines; D013449:Sulfonamides; D044005:Tetrahydroisoquinolines; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; D000077409:Tamsulosin; C005419:oxybutynin; D000069464:Solifenacin Succinate
keywords: Adrenergic α1-receptor antagonists; Benign prostatic hyperplasia; Disease management; Health resources; Lower urinary tract symptoms; Muscarinic antagonists; Persistence; Storage symptoms