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1.
Am J Med ; 136(10): 1000-1010.e7, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37481022

RESUMO

BACKGROUND: Five-alpha reductase inhibitors (5αRIs) are used to treat benign prostatic hyperplasia (BPH). However, the cardiovascular effects of 5αRIs remain poorly understood. The study objective was to compare the rate of hospitalization for heart failure among men with BPH prescribed 5αRIs to that of men with BPH not prescribed BPH medications. METHODS: Using the Clinical Practice Research Datalink linked with hospitalization and vital statistics data, we conducted a population-based cohort study among patients newly diagnosed with BPH. We defined exposure as the current use of 5αRIs, current use of alpha-blockers, and no current use of BPH medications in a time-varying approach. The primary endpoint was hospitalization for heart failure, and secondary endpoints were myocardial infarction, stroke, and cardiovascular death. We used time-dependent Cox-proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Our cohort included 94,440 men with incident BPH. A total of 3893 hospitalizations for heart failure occurred over 527,660 person-years of follow-up (incidence rate 7.38; 95% CI, 7.15-7.61, per 1000 person-years). Compared with no current use of BPH medications, current use of 5αRIs was not associated with an increased risk of hospitalization for heart failure (HR 0.94; 95% CI, 0.86-1.03), myocardial infarction (HR 0.92; 95% CI, 0.81-1.05), stroke (HR 0.94; 95% CI, 0.85-1.05), or cardiovascular death (HR 0.89; 95% CI, 0.80-0.99). CONCLUSIONS: The use of 5αRIs was not associated with an increased risk of hospitalization for heart failure, myocardial infarction, stroke, or cardiovascular death compared with non-use.


Assuntos
Insuficiência Cardíaca , Infarto do Miocárdio , Hiperplasia Prostática , Acidente Vascular Cerebral , Masculino , Humanos , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/complicações , Inibidores de 5-alfa Redutase/efeitos adversos , Estudos de Coortes , Inibidores Enzimáticos/uso terapêutico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/complicações , Infarto do Miocárdio/complicações , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/induzido quimicamente , Oxirredutases/uso terapêutico
2.
Br J Clin Pharmacol ; 88(8): 3771-3781, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35301747

RESUMO

5-α reductase inhibitors (5αRIs) are effective for the treatment of benign prostatic hyperplasia (BPH). However, 5αRIs could lower levels of haemoglobin, increasing the risk of anaemia. The objective of this study was to compare the rate of anaemia between new users of 5αRIs and α-blockers in the UK. METHODS: We conducted a matched, active comparator, new-user cohort study using the Clinical Practice Research Datalink. The study population consisted of men aged ≥40 years with incident BPH who initiated 5αRIs between 1998 and 2019 and were matched 1:1 on propensity score to new users of α-blockers. Anaemia was defined by a measured haemoglobin <130 g/L. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for anaemia. RESULTS: Our study cohort included 9429 new users of 5αRIs and 9429 matched new users of α-blockers. Their median durations of follow-up were 136 days (interquartile range: 54-336 d) and 77 days (interquartile range: 58-236 d), respectively. A total of 2865 5αRIs users and 2407 α-blocker users developed incident anaemia, representing rates of 37.3 (95% CI: 33.6-41.3) and 42.0 (95% CI: 38.1-46.2) per 100 person-years, respectively. The use of 5αRIs was not associated with an increased risk of anaemia compared to the use of α-blockers (HR: 0.95, 95% CI: 0.90-1.00). Similarly, we did not observe an increased risk of mild, moderate, or severe anaemia. CONCLUSION: The use of 5αRIs was not associated with an increased risk of anaemia compared to the use of α-blockers among men with BPH.


Assuntos
Anemia , Hiperplasia Prostática , Inibidores de 5-alfa Redutase/efeitos adversos , Antagonistas Adrenérgicos alfa/efeitos adversos , Anemia/induzido quimicamente , Anemia/epidemiologia , Estudos de Coortes , Humanos , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/epidemiologia
3.
World J Urol ; 39(6): 2019-2028, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32909173

RESUMO

PURPOSE: To describe trends in the pharmacological treatment of BPH in the United Kingdom (UK) from 1998 to 2016. METHODS: We created a cohort of men with a diagnosis of BPH between 1998 and 2016 using the Clinical Practice Research Datalink. Using Poisson regression, we estimated annual prescription rates of 5αRIs, α-blockers, and combination therapy (5αRIs + α-blockers). Adherence was defined by a proportion of days covered > 80%. RESULTS: Our cohort included 192,640 men with BPH who generated 1,176,264 person-years (PYs) of follow-up. The mean age was 68.0 (standard deviation: 10.7) years. The prescription rate of all BPH medications during the study period was 347.6 per 100 PYs (95% CI 347.2-347.9). α-Blockers had the highest prescription rate (222.9 per 100 PYs, 95% CI 222.7-223.2); prescription rates of 5αRIs and combination therapy were 69.1 per 100 PYs (95% CI 69.0-69.3) and 55.5 per 100 PYs (95% CI 55.4-55.7), respectively. The prescription rate for combination therapy was 19 times greater in 2013-2016 than in 1998-2000 (rate ratio: 19.2, 95% CI 18.6-19.7), while the prescription rates for 5αRIs and α-blockers each doubled during this period (rate ratio: 1.86, 95% CI 1.84-1.88 and rate ratio: 2.02, 95% CI 2.01-2.04, respectively). The proportion of patients who were adherent at 1 year to 5αRIs (32.3%), α-blockers (44.0%), and combination therapy (45.6%) was low. CONCLUSION: The prescription rate of BPH medications increased substantially between 1998 and 2016 in the UK, with the greatest relative increase observed with combination therapy. Adherence to BPH medications was low in this population-based study.


Assuntos
Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Hiperplasia Prostática/terapia , Idoso , Estudos de Coortes , Tratamento Farmacológico/tendências , Quimioterapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Reino Unido
4.
PLoS One ; 10(11): e0142290, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26551023

RESUMO

BACKGROUND: Infection with Human Immunodeficiency virus (HIV) is an important risk factor for Tuberculosis (TB). Anti-Retroviral Therapy (ART) has improved the prognosis of HIV and reduced the risk of TB infected patients. Isoniazid Preventive Therapy (IPT) aims to reduce the development of active TB in patients with latent TB. OBJECTIVE: Systematically review and synthesize effect estimates of IPT for TB prevention in adult HIV patients. Secondary objectives were to assess the effect of IPT on HIV disease progression, all-cause mortality and adverse drug reaction (ADR). SEARCH STRATEGY: Electronic databases were searched to identify relevant articles in English available by September 11th 2015. SELECTION CRITERIA: Research articles comparing IPT to placebo or no treatment in HIV infected adults using randomized clinical trials. DATA ANALYSIS: A qualitative review included study-level information on randomization and treatment allocation. Effect estimates were pooled using random-effects models to account for between-study heterogeneity. MAIN RESULTS: This review assessed ten randomized clinical trials that assigned 7619 HIV patients to IPT or placebo. An overall 35% of TB risk reduction (RR = 0.65, 95% CI (0.51, 0.84)) was found in all participants, however, larger benefit of IPT was observed in Tuberculin Skin Test (TST) positive participants, with pooled relative risk reduction of 52% [RR = 0.48; 95% CI (0.29, 0.82)] and with a prediction interval ranging from 0.13 to 1.81. There was no statistically significant effect of IPT on TB occurrence in TST negative or unknown participants. IPT also reduced the risk of HIV disease progression in all participants (RR = 0.69; 95% CI (0.48, 0.99)) despite no benefits observed in TST strata. All-cause mortality was not affected by IPT although participants who had 12 months of IPT tend to have a reduced risk (RR = 0.65; 95% CI(0.47, 0.90)). IPT had an elevated, yet statistically non-significant, risk of adverse drug reaction [RR = 1.20; 95% CI (1.20, 1.71)]. Only a single study assessed the effect of IPT in combination with ART in preventing TB and occurrence of multi-drug resistant tuberculosis. CONCLUSIONS: IPT use substantially contributes in preventing TB in persons with HIV in general and in TST positive individuals in particular. More evidence is needed to explain discrepancies in the protective effect of IPT in these individuals.


Assuntos
Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV , Isoniazida/uso terapêutico , Tuberculose/prevenção & controle , Antituberculosos/administração & dosagem , Antituberculosos/efeitos adversos , Infecções por HIV/epidemiologia , Infecções por HIV/patologia , Humanos , Isoniazida/administração & dosagem , Isoniazida/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
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