BPH Drug Prescribing Increasing in the U.S.

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SAN DIEGO—Physicians in the U.S. increasingly have been prescribing pharmacotherapy to treat lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH), according to data from two studies presented at the American Urological Association annual meeting.

In an analysis of National Ambulatory Medical Care Survey 1993-2010 data, Christopher P. Filson, MD, and colleagues at the University of Michigan in Ann Arbor found more than 102 million outpatient visits for men with BPH/LUTS. The most commonly prescribed drug class was alpha blockers. The proportion of visits in which physicians prescribed alpha blockers alone rose from 8.3% in 1993 to nearly 20% in 2010. The use of 5-alpha-reductase inhibitors (5-ARIs) alone increased from 3.2% of visits in 1993 to 7.5% of visits in 2009-2010. The use of anticholinergics alone increased from 1.2% of visits in 1999-2000 to 5.3% of visits in 2009-2010.

In the modern era, the researchers noted, tamsulosin was the most common alpha blocker prescribed, accounting for the majority of alpha blocker prescriptions from 2008-2010. Prior to the introduction of tamsulosin in 1996, urologists were no more likely to prescribe alpha blockers than primary care physicians; after tamsulosin became available, urologists were nearly twice as likely to prescribe alpha blockers, a finding that suggests urologists may adopt novel medications more readily than primary care providers.

This finding is important because primary care physicians provide a large portion of BPH care in the U.S, said Dr. Filson, who is a research fellow. “Understanding these [prescribing] differences may help reveal educational barriers or differences in severity of disease in terms of the patients that primary care providers and urologists treat,” he told Renal & Urology News.

The other study examined trends in the medical management of BPH/LUTS in the Veterans Affairs Healthcare System. The study, by Bradley Erickson, MD, and collaborators at the University of Iowa Carver College of Medicine in Iowa City, showed that the proportion of men who were prescribed pharmacotherapy within 90 days of diagnosis increased from 32.2% in 2003-2004 to 44.8% in 2009-2010.

The increase was greater among men aged 40-59 than men aged 60 or older. Alpha blockers were the most common prescribed drugs, and their use remained stable during the study period (86.4% and 85.8% of prescriptions in 2003-2004 and 2009-2010, respectively). Moreover, from 2003 to 2010, 5-ARI use increased from 12.9% to 17% of prescriptions, while the use of anticholinergic drugs decreased from 6.6% to 4.4% of prescriptions.

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