Titration and persistence with tamsulosin among men with benign prostatic hyperplasia in a large managed care population
Davis, K. L., Mauskopf, J., Chow, W., Chao, J., & Seal, B. (2006, April). Titration and persistence with tamsulosin among men with benign prostatic hyperplasia in a large managed care population. Presented at Academy of Managed Care Pharmacy 18th Annual Meeting, .
Introduction: This study assessed patterns of titration and persistence with tamsulosin, the first FDA approved selective alpha-adrenergic blocker indicated for the treatment of benign prostatic hyperplasia (BPH), in a managed care population. Methods: This retrospective analysis evaluated dosing and refill patterns from medical claims of 33,671 men in the PharMetrics database with a BPH diagnosis and treatment with tamsulosin between 10/8/99 and 1/31/05. The rate and magnitude of titrations, medication possession ratio (MPR), and time to discontinuation (defined as a refill gap of > 60 days) were estimated. Use of other medications and prostate surgeries following initial prescription were also documented. Results: Among patients with at least two valid tamsulosin doses (N = 27,350), 3,522 (12.5%) titrated upward following initial dose, while 946 patients (3.5%) had at least one downward titration. Of those with an upward titration, 3,330 (94.5%) had at least one doubling of dose. The average dose at first titration was 0.90 mg/day, compared to an average starting dose of 0.44 mg/day across all prescriptions observed. The first upward titration for 1,946 patients (55.3%) occurred within 6 months of initial prescription. Among all patients, 17,158 (50.9%) discontinued tamsulosin, with an average time to discontinuation of 187 days. The average MPR for tamsulosin was 0.42. Among all patients, 6,492 (19.3%) had at least one claim for another BPH medication while 2,618 (7.8%) required prostate surgery following initial tamsulosin prescription. Transurethral resection of the prostate (TURP) was the most common, representing 77.6% of all surgeries received. Conclusions: Results indicate that more than 10% of BPH patients who start on tamsulosin require an upward dose titration and approximately half appear to take a drug holiday at some point during treatment. Cost of therapy and potential side effects that result from dose escalation should be considered in a drug with high utilization.