Drug Discontinuation - TRT & ASIH

[Michael Scally MD]

It sure appears that the ignored what happens after stopping AAS/TRT.

Reidenberg MM. Drug Discontinuation Effects Are Part of the Pharmacology of a Drug. Journal of Pharmacology and Experimental Therapeutics 2011;339(2):324-8. Drug Discontinuation Effects Are Part of the Pharmacology of a Drug

Most reviews of drug withdrawal effects focus on drugs of potential abuse such as opioids, benzodiazepines, etc. Abrupt discontinuation of many other drugs used in medicine cause withdrawal syndromes, some of which can be fatal.

Discontinuation of a number of cardiovascular drugs can increase risk of cardiovascular events above that of people not taking these drugs. These include β-adrenergic receptor antagonists, aspirin, HMG-CoA reductase inhibitors (statins), and heparin. Rebound hypertension occurs after abrupt cessation of many antihypertensive drugs.

The possibility of discontinuation syndromes has usually been neglected until adverse clinical events force them to be noticed. Attention to the possibility of drug discontinuation effects is an important part of drug safety evaluation.

 

[Michael Scally MD]

Shortridge EF, Polzer P, Donga P, et al. Experiences and treatment patterns of hypogonadal men in a U.S. health system. Int J Clin Pract. Experiences and treatment patterns of hypogonadal men in a U.S. health system - Shortridge - 2014 - International Journal of Clinical Practice - Wiley Online Library

OBJECTIVE: To examine self-reported experiences with hypogonadism (HG) and patterns of testosterone replacement therapy (TRT) in men seeking care in a U.S. healthcare system.

METHODS: Men >/= 18 years old with HG were identified from the 2008-2010 Reliant electronic medical records database. Surveys, including validated instruments for measuring symptoms of HG, were collected and evaluated for demographic and behavioural data.

RESULTS: Surveys were mailed to 133 men with HG in 2012. Of the 107 surveys returned, 95 were included in the final analysis. Most respondents were Caucasian (90.5%). Men reported developing symptoms of HG, as well as being diagnosed, at a median age of 50 years.

The most common symptoms reported as reasons for seeking treatment were erectile dysfunction (66.3%), fatigue (59.0%) and decreased sex drive (57.9%).

These continued to be the most bothersome symptoms at the time of the survey regardless of whether the patient received treatment, although men who were currently taking TRT reported less severe symptoms. Approximately 88% of men reported taking TRT at some point, with 61.9% on therapy at the time of the survey.

CONCLUSIONS: This study examined men's experiences with HG, including symptoms, quality of life, and treatments.

Some symptoms continued despite treatment, and therapy was discontinued at a high rate, which men generally attributed to cost and perceptions of efficacy.
In light of this lack of adherence, patients may benefit from appropriate expectation setting regarding reasonable timelines for symptom improvement, the strengths and challenges of various TRT formulations, the importance of adherence and the benefits and risks of TRT.

 

[Michael Scally MD]

Medication Treatment Patterns Among Hypogonadal Men Initiated Topical Testosterone Agents
http://edrv.endojournals.org/cgi/content/meeting_abstract/34/03_MeetingAbstracts/OR32-4

Introduction: Little is known about treatment patterns among hypogonadal men who initiated topical testosterone therapy (TRT).

Objective: To describe patient characteristics and treatment patterns in hypogonadal men initiating TRT with AndroGel or Testim, and examine factors associated with medication adherence and persistence.

Methods: The study group consists of 15,435 hypogonadal men 18 years from the Thomson Reuters MarketScan® Database, who initiated a topical testosterone prescription in 2009 without evidence of testosterone medication in the previous 6 months. TRT treatment patterns were observed for 12 months. Patients were required to have continuous pharmaceutical and medical benefit enrollment for 12 months before and 12 months following initiation of TRT. Medication continuation was defined as having index drug refills in the 1-year follow-up period with medication gaps 30 days between consecutive prescriptions. Restarting was defined as a refill of the index drug after a medication gap of >30 days. As a sensitivity analysis, several medication adherence definitions were examined based on prescription gaps of 60 and 90 days. A multiple logistic regression analysis was conducted to identify key factors associated with adherence.

Results: Treatment patterns were similar for both medications. Only 11% of testosterone initiators continued medication for 1 year. When patients resumed therapy, most (~90%) used the same medication and dose. Restarting or changing medication was often done within the first 90 days after discontinuation of therapy. When the medication gap increased to 60 and 90 days, there was no change in adherence, persistence, and length of therapy (LOT) showed only modest increases.

Among comorbidities, significantly fewer men reported erectile dysfunction (ED) and chronic fatigue syndrome at follow-up than at baseline (all p<0.05). A significant increase in the use of PDE5 inhibitors was seen after initiation of TRT. Adherence was better in older and in non-diabetic patients (all p<0.05).

Conclusions: There is limited information in the literature about continuation rates for men on TRT; although, consistent with the literature on chronic diseases generally, rates of adherence and persistence are low. This study supports the literature, and indicates that adherence rates are not sensitive to several increasing continuation rate definitions.

 

[Oregongearhead]

Im just waiting for my TRT doc to tell me my insurance will no longer pay for my testosterone treatment because of possible cardiac risks .......thats the day I go rogue. ~OGH

 

[Michael Scally MD]

Schoenfeld MJ, Shortridge E, Cui Z, Muram D. Medication Adherence and Treatment Patterns for Hypogonadal Patients Treated with Topical Testosterone Therapy: A Retrospective Medical Claims Analysis. The Journal of Sexual Medicine. Medication Adherence and Treatment Patterns for Hypogonadal Patients Treated with Topical Testosterone Therapy: A Retrospective Medical Claims Analysis - Schoenfeld - 2013 - The Journal of Sexual Medicine - Wiley Online Library

Introduction There is limited information on adherence to topical testosterone replacement therapy (TRT) among hypogonadal men.

Aim To determine adherence rates among men treated with topical testosterone gels and to examine factors that may influence adherence, including age, presence of a specific diagnosis, and index dose.

Methods Included were 15,435 hypogonadal men, from the Thomson Reuters MarketScan® Database, who had an initial topical testosterone prescription in 2009 and who were followed for 12?months.

Main Outcome Measures Adherence to testosterone was measured by medication possession ratio (MPR), with high adherence defined as ?0.8. Persistence was defined as the duration of therapy from the index date to the earliest of the following events: end date of the last prescription, date of the first gap of >30 days between prescriptions, or end of the study period (12?months).

Results Adherence to topical TRT was low.

By 6?months, only 34.7% of patients had continued on medication; at 12?months, only 15.4%.

Adherence rates were numerically similar among men who received AndroGel® or Testim® topical gels and did not differ among men of different age groups.

Approximately 80% of patients initiated at the recommended dose of 50?mg/day. Over time, an increased proportion of men used a higher dose. This change was the result of dose escalation, rather than of greater adherence among men initiating therapy at a high dose. Dose escalation was seen as early as 1?month into therapy.

Approximately 50% of men who discontinued treatment resumed therapy; most men used the same medication and dose.

Conclusions Discontinuation rates are high among hypogonadal men treated with testosterone gels, irrespective of their age, diagnosis, and index dose. Further study, evaluating other measurable factors associated with low adherence among patients receiving topical TRT, may lead to interventions designed to improve adherence with therapy.