Understanding Treatment Response in Individual Profiles of Men with Prostatic Enlargement at Risk of Progression.
Male
Humans
Dutasteride
/ therapeutic use
Tamsulosin
/ therapeutic use
Azasteroids
/ therapeutic use
Sulfonamides
/ therapeutic use
Treatment Outcome
Drug Therapy, Combination
Prostatic Hyperplasia
/ complications
Urinary Retention
/ complications
Lower Urinary Tract Symptoms
/ etiology
Disease Progression
Benign prostatic enlargement
Benign prostatic hyperplasia
Combination treatment
Disease progression
Dutasteride
Lower urinary tract symptoms
Predictive modelling
Tamsulosin
Treatment response
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
29
04
2022
revised:
06
07
2022
accepted:
19
07
2022
pubmed:
20
8
2022
medline:
15
2
2023
entrez:
19
8
2022
Statut:
ppublish
Résumé
It is unclear how cumulative multivariable effects of clinically relevant covariates impact response to pharmacological treatments for lower urinary tract symptoms (LUTS)/benign prostatic enlargement (BPE). To develop models to predict treatment response in terms of International Prostate Symptom Score (IPSS) and the risk of acute urinary retention (AUR) or BPE-related surgery, based on large data sets and using as predictors baseline characteristics that commonly define the risk of disease progression. A total of 9167 patients with LUTS/BPE at risk of progression in three placebo-controlled dutasteride trials and one comparing dutasteride, tamsulosin, and dutasteride + tamsulosin combination therapy (CT) were included in the analysis to predict response to placebo up to 24 mo and active treatment up to 48 mo. Predictors included age, IPSS, total prostate volume (PV), maximum urinary flow rate (Q The vast majority of patients benefit from dutasteride or CT when compared with tamsulosin alone. The predicted IPSS improvement with dutasteride or CT increased with greater PV and severity of symptoms at baseline. The tamsulosin effect was lower with greater baseline PV and tended to decrease over time. Predicted AUR/surgery risk was greater with tamsulosin versus CT or dutasteride; this risk increased with larger PV, higher PVR, and lower Q Predictive modelling based on large data sets and visualisation of the risk for individual profiles can improve our understanding of how risk factors for disease progression interact and affect response to different treatments, reinforcing the importance of an individualised approach for LUTS/BPE management. We used data from previous studies to develop statistical models for predicting how men with lower urinary tract symptoms or benign prostate enlargement and at risk of disease complications respond to certain treatments according to their individual characteristics.
Sections du résumé
BACKGROUND
It is unclear how cumulative multivariable effects of clinically relevant covariates impact response to pharmacological treatments for lower urinary tract symptoms (LUTS)/benign prostatic enlargement (BPE).
OBJECTIVE
To develop models to predict treatment response in terms of International Prostate Symptom Score (IPSS) and the risk of acute urinary retention (AUR) or BPE-related surgery, based on large data sets and using as predictors baseline characteristics that commonly define the risk of disease progression.
DESIGN, SETTING, AND PARTICIPANTS
A total of 9167 patients with LUTS/BPE at risk of progression in three placebo-controlled dutasteride trials and one comparing dutasteride, tamsulosin, and dutasteride + tamsulosin combination therapy (CT) were included in the analysis to predict response to placebo up to 24 mo and active treatment up to 48 mo.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Predictors included age, IPSS, total prostate volume (PV), maximum urinary flow rate (Q
RESULTS AND LIMITATIONS
The vast majority of patients benefit from dutasteride or CT when compared with tamsulosin alone. The predicted IPSS improvement with dutasteride or CT increased with greater PV and severity of symptoms at baseline. The tamsulosin effect was lower with greater baseline PV and tended to decrease over time. Predicted AUR/surgery risk was greater with tamsulosin versus CT or dutasteride; this risk increased with larger PV, higher PVR, and lower Q
CONCLUSIONS
Predictive modelling based on large data sets and visualisation of the risk for individual profiles can improve our understanding of how risk factors for disease progression interact and affect response to different treatments, reinforcing the importance of an individualised approach for LUTS/BPE management.
PATIENT SUMMARY
We used data from previous studies to develop statistical models for predicting how men with lower urinary tract symptoms or benign prostate enlargement and at risk of disease complications respond to certain treatments according to their individual characteristics.
Identifiants
pubmed: 35985933
pii: S2405-4569(22)00165-1
doi: 10.1016/j.euf.2022.07.004
pii:
doi:
Substances chimiques
Dutasteride
O0J6XJN02I
Tamsulosin
G3P28OML5I
Azasteroids
0
Sulfonamides
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
178-187Informations de copyright
Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.