5α-Reductase Inhibitor Use and Suicide Risk Examined in Older Patients
HealthDay News — For older men, initiation of a new prescription of a 5α-reductase inhibitor for the treatment of benign prostatic hyperplasia is not associated with increased risk of suicide, according to a study published online March 20 in JAMA Internal Medicine.
Blayne Welk, MD, from Western University in London, Canada, and colleagues conducted a retrospective cohort study using linked administrative data for 93,197 men ages 66 years or older who initiated a new prescription for a 5α-reductase inhibitor during 2003 to 2013. Participants were propensity score-matched to an equal number of men not prescribed a 5α-reductase inhibitor.
The researchers observed no increased risk of suicide for men who used 5α-reductase inhibitors (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.53 to 1.45). During the initial 18 months after initiation of a 5α-reductase inhibitor, but not thereafter, the risk of self-harm was significantly increased (HR, 1.88; 95% CI, 1.34 to 2.64). During the initial 18 months after initiation of a 5α-reductase inhibitor, the risk of incident depression was elevated (HR, 1.94; 95% CI, 1.73 to 2.16), and the elevation continued, to a lesser extent, for the remainder of the follow-up period (HR, 1.22; 95% CI, 1.08 to 1.37). For these two outcomes, the absolute increases in the event rates were 17 and 237 per 100,000 patient-years, respectively.
"This is in keeping with post-marketing experience and patient concerns, and discontinuation of the medication in these circumstances may be appropriate," the authors write.
One author disclosed financial ties to Astellas.