BPH pharmacotherapy
In the entire study group, the
most commonly used pharmacotherapy was ARAs in monotherapy – 36.6%, or
in a combination therapy with 5αRIs – 30.9%. MRAs were prescribed
either with ARAs – 11.2%, or on top of ARA+5αRI therapy – 30.9%.
Mirabegron, the only available in Poland selective
β3-adrenoceptors agonist, was used in 1.4% of men only
(Tab. 1).
Patients with storage symptoms were more frequently prescribed with MRA
containing pharmacotherapy and/or mirabegron (43.1% vs. 5.0%; p
< 0.001; and 2.4% vs 0.3%; p < 0.001;
respectively). Of note, 54.5% of patients with storage symptoms were
not treated with MRAs and/or β3-adrenergic receptors
agonists.
In the subgroup of patients with storage symptoms increasing severity of
LUTS accounted for more frequent prescription of MRA-based
pharmacotherapy (from 2.1% in patients with mild, through 29.1% with
moderate, to 42.8% with severe LUTS). In patients with moderate LUTS
MRAs were used with similar frequency with ARAs and with ARA+5αRI; while
in individuals with severe LUTS much more frequently on top of ARA+5αRI
therapy (Tab. 2).
Tamsulosin was the most commonly used ARA (70.1%), while doxazosin
(20.0%) and alfuzosin (6.2%) came second and third. With the
increasing severity of LUTS, the prescription of doxazosin within ARAs
was increasing (from 16.9 to 24.4%, p < 0.001), while the
prescription of alfuzosin was decreasing (from 5.8 to 3.3%; p
< 0.001). The occurrence of urinary urgency was associated
with more frequent use of doxazosin (14.0 vs 22.4%; p <
0.001) but less frequent use of tamsulosin (75.1 vs 68.0%; p
< 0.001) and alfuzosin (7.5 vs 5.7%; p < 0.001).
The data concerning the use of specific 5αRIs was not collected, as
finasteride is the almost exclusively used 5αRI in Poland.
Of the available MRAs, tolterodine (20.2%) and solifenacin (9.0%) were
most commonly used; while oxybutynin (1.4%), and darifenacin (0.1%)
were used much less frequently.