Effect of dutasteride on clinical progression of benign prostatic hyperplasia in asymptomatic men with enlarged prostate: a post hoc analysis of the REDUCE study

Paul Toren, David Margel, Girish Kulkarni, Antonio Finelli, Alexandre Zlotta, Neil Fleshner, Paul Toren, David Margel, Girish Kulkarni, Antonio Finelli, Alexandre Zlotta, Neil Fleshner

Abstract

Objective: To assess the role of dutasteride in preventing clinical progression of benign prostatic hyperplasia in asymptomatic men with larger prostates.

Design: Post hoc analysis of four year, double blind Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study

Participants: 1617 men randomised to dutasteride or placebo with a prostate size >40 mL and baseline International Prostate Symptom Score (IPSS) <8. Subjects who took medications for benign prostatic hyperplasia were excluded at study entry.

Interventions: Placebo or dutasteride 0.5 mg daily.

Main outcome measures: Comparison of risk of clinical progression of benign prostatic hyperplasia at four years (defined as a ≥ 4 point worsening on IPSS, acute urinary retention, urinary tract infection, or surgery related to benign prostatic hyperplasia).

Results: 825 participants took placebo, 792 took dutasteride. A total of 464 (29%) experienced clinical progression benign prostatic hyperplasia, 297(36%) taking placebo, 167 (21%) taking dutasteride (P<0.001). The relative risk reduction was 41% and the absolute risk reduction 15%, with a number needed to treat (NNT) of 7. Among men who had acute urinary retention and surgery related to benign prostatic hyperplasia, the absolute risk reduction for dutasteride was 6.0% and 3.8%, respectively. On multivariable regression analysis adjusting for covariates, dutasteride significantly reduced clinical progression of benign prostatic hyperplasia with an odds ratio of 0.47 (95% CI 0.37 to 0.59, P<0.001). Analysis of time to first event yielded a hazard ratio of 0.673 (P<0.001) for those taking dutasteride. Sexual adverse events were most common and similar to prior reports.

Limitations: Further prospective studies may be warranted to demonstrate generalisability of these results.

Conclusions: This study is the first to explore the benefit of treating asymptomatic or mildly symptomatic men with an enlarged prostate. Dutasteride significantly decreased the incidence of benign prostatic hyperplasia clinical progression.

Trial registration: ClinicalTrials.gov NCT00056407.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; AF, NF, and AZ have received research grants and honorariums from GlaxoSmithKline; NF and AF do consultancy for GlaxoSmithKline and Merck; no other relationships or activities that could appear to have influenced the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790804/bin/torp006771.f1_default.jpg
Fig 1 Absolute rates and relative risk reduction for acute urinary retention, surgery related to benign prostatic hyperplasia, and clinical progression of benign prostatic hyperplasia among 1617 asymptomatic men with enlarged prostate glands who were randomised to treatment with dutasteride or placebo
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790804/bin/torp006771.f2_default.jpg
Fig 2 Time to first event indicating progression of benign prostatic hyperplasia among 1617 asymptomatic men with enlarged prostate glands who were randomised to treatment with dutasteride or placebo

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