Treatment with 5-alpha reductase inhibitors (5ARIs) was not associated with an increased risk of death in patients with benign prostatic hyperplasia (BPH), according to a new study published in the journal Urology.

Researchers conducted a retrospective matched cohort study to compare the risk of death among BPH patients treated with 5ARIs, as monotherapy or in combination with alpha-blockers, with those treated with alpha-blockers alone. Men were eligible if they were ≥50 years old, were on a medication for BPH or lower urinary tract symptoms (LUTS) between 1992 and 2008, and had ≥3 consecutive prescriptions (N=174,895); adjusted hazard ratios were used to estimate the primary outcome of mortality due to all-causes. 

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Within the 19-year study period (543,523 person-years of follow-up), there were 35,266 deaths, 18.9% of the 5ARI users and 20.4% of the alpha-blocker users. Compared with alpha-blocker use, 5ARIs were not linked to an increased risk of mortality (adjusted hazard ratio [HR]: 0.64, 95% CI 0.62, 0.66), after adjusting for matching factors (age, race, region, drug initiation year, history of alpha-blocker use, Charlson score, comorbidities). Among men who were treated for >2 years, the use of 5ARIs was associated with a 46% reduction in mortality risk compared with alpha-blocker use (adjusted HR: 0.54; 95% CI 0.51, 0.57).

“These data provide reassurance about the safety of using 5ARIs in general practice to manage BPH/LUTS,” concluded the authors.  

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