Outcomes of dutasteride discontinuation in patients with benign prostatic hypertrophy
https://doi.org/10.4081/aiua.2022.4.521
Submitted: October 30, 2022
Accepted: November 19, 2022
Published: December 28, 2022
Accepted: November 19, 2022
Abstract Views: 1248
PDF: 1157
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
To the Editor,
Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in elderly males. The current guidelines recommend the use of a 5-alpha reductase inhibitor (5ARI) to treat males with moderate-to-severe LUTS and an enlarged prostate. Combination therapy with an alpha blocker and a 5ARI has proven effective at ameliorating LUTS and reducing the total prostate volume (TPV) and the risk of the disease progression.
1. Gratzke C, Bachmann A, Descazeaud A, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015; 67(6):1099-1109.
2. McConnell JD, Roehrborn CG, Bautista OM, et al. Medical Therapy of Prostatic Symptoms (MTOPS) Research Group: The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Eng J Med. 2003; 349(25):2387-2398.
3. Roehrborn CG, Siami P, Barkin J, et al. CombAT Study Group: The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol. 2008; 179(2):616-621.
4. Roehrborn CG, Siami P, Barkin J, et al. CombAT Study Group: The influence of baseline parameters on changes in international prostate symptom score with dutasteride, tamsulosin, and combination therapy among men with symptomatic benign prostatic hyperplasia and an enlarged prostate: 2-year data from the CombAT study. Eur Urol. 2009; 55(2):461-471.
5. Roehrborn CG, Siami P, Barkin J, et al. CombAT Study Group: The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010; 57(1):123-131.
6. Rothschild JM, Bastes DW, Leape LL: Preventable medical injuries in older patient. Arch Intern Med. 2000; 160(18):2717-2728.
7. Suzuki Y, Akishita M, Arai H, Teramoto S, Morimoto S, Toba K. Multiple consultations and polypharmacy of patients attending geriatric outpatient units of university hospitals. Geriatr Gerontol Int. 2006; 6(4): 244-247.
8. Kojima T, Akishita M, Kameyama Y, et al. High risk of adverse drug reactions in elderly patients taking six or more drugs: analysis of inpatient database. Geriatr Gerontol Int. 2012; 12(4):761-762.
9. Kojima T, Akishita M, Nakamura T, et al. Polypharmacy as a risk for fall occurrence. Geriatr Gerontol Int. 2012; 12(3):425-430.
10. Barkin J, Guimaraces M Jacobi G, Pushkar D, Taylor S, van Vierssen TripOB. Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride. Eur Urol. 2003; 44(4): 461-466.
11. Shindo T, Hashimoto K, Shimizu T, Itoh N, Masumori N. Significance of intraprostatic architecture and regrowth velocity for considering discontinuation of dutasteride after combination therapy with an alpha blocker: a prospective, pilot study. KJU. 2015; 56(4):305-309.
12. Welk B, McArthur E, Ordon M, et al, Association of Suicidality and Depression With 5alpha-Reductase Inhibitors. JAMA intern Med. 2017; 177(5):683-691.
13. Lin VC, Liao CH, Kuo HC. Progression of lower urinary tract symptoms after discontinuation of 1 medication from 2-year combined alpha-blocker and 5-alpha-reductase inhibitor therapy for benign prostatic hyperplasia in men--a randomized multicenter study. Urology. 2014; 83(2):416-421.
14. Jeong YB, Kwon KS, Kim SD, Kim HJ. Effect of discontinuation of 5alpha-reductase inhibitors on prostate volume and symptoms in men with BPH: a prospective study. Urology. 2009; 73(4):802-806.
15. Nørgaard M, Horváth-Puhó E, Corraini P, Sørensen HT, Henderson VW. Sleep disruption and Alzheimer's disease risk: Inferences from men with benign prostatic hyperplasia. EClinical Medicine. 2021; 32:100740.
2. McConnell JD, Roehrborn CG, Bautista OM, et al. Medical Therapy of Prostatic Symptoms (MTOPS) Research Group: The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Eng J Med. 2003; 349(25):2387-2398.
3. Roehrborn CG, Siami P, Barkin J, et al. CombAT Study Group: The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol. 2008; 179(2):616-621.
4. Roehrborn CG, Siami P, Barkin J, et al. CombAT Study Group: The influence of baseline parameters on changes in international prostate symptom score with dutasteride, tamsulosin, and combination therapy among men with symptomatic benign prostatic hyperplasia and an enlarged prostate: 2-year data from the CombAT study. Eur Urol. 2009; 55(2):461-471.
5. Roehrborn CG, Siami P, Barkin J, et al. CombAT Study Group: The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010; 57(1):123-131.
6. Rothschild JM, Bastes DW, Leape LL: Preventable medical injuries in older patient. Arch Intern Med. 2000; 160(18):2717-2728.
7. Suzuki Y, Akishita M, Arai H, Teramoto S, Morimoto S, Toba K. Multiple consultations and polypharmacy of patients attending geriatric outpatient units of university hospitals. Geriatr Gerontol Int. 2006; 6(4): 244-247.
8. Kojima T, Akishita M, Kameyama Y, et al. High risk of adverse drug reactions in elderly patients taking six or more drugs: analysis of inpatient database. Geriatr Gerontol Int. 2012; 12(4):761-762.
9. Kojima T, Akishita M, Nakamura T, et al. Polypharmacy as a risk for fall occurrence. Geriatr Gerontol Int. 2012; 12(3):425-430.
10. Barkin J, Guimaraces M Jacobi G, Pushkar D, Taylor S, van Vierssen TripOB. Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride. Eur Urol. 2003; 44(4): 461-466.
11. Shindo T, Hashimoto K, Shimizu T, Itoh N, Masumori N. Significance of intraprostatic architecture and regrowth velocity for considering discontinuation of dutasteride after combination therapy with an alpha blocker: a prospective, pilot study. KJU. 2015; 56(4):305-309.
12. Welk B, McArthur E, Ordon M, et al, Association of Suicidality and Depression With 5alpha-Reductase Inhibitors. JAMA intern Med. 2017; 177(5):683-691.
13. Lin VC, Liao CH, Kuo HC. Progression of lower urinary tract symptoms after discontinuation of 1 medication from 2-year combined alpha-blocker and 5-alpha-reductase inhibitor therapy for benign prostatic hyperplasia in men--a randomized multicenter study. Urology. 2014; 83(2):416-421.
14. Jeong YB, Kwon KS, Kim SD, Kim HJ. Effect of discontinuation of 5alpha-reductase inhibitors on prostate volume and symptoms in men with BPH: a prospective study. Urology. 2009; 73(4):802-806.
15. Nørgaard M, Horváth-Puhó E, Corraini P, Sørensen HT, Henderson VW. Sleep disruption and Alzheimer's disease risk: Inferences from men with benign prostatic hyperplasia. EClinical Medicine. 2021; 32:100740.
Masuda, H., Mikami, K., Otsuka, K., Hou, K., Suyama, T., Araki, K., Kojima, S., & Naya, Y. (2022). Outcomes of dutasteride discontinuation in patients with benign prostatic hypertrophy. Archivio Italiano Di Urologia E Andrologia, 94(4), 521–524. https://doi.org/10.4081/aiua.2022.4.521
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