Urologists no longer primary initiator of tamsulosin

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Urologists are no longer the primary initiators of tamsulosin (Flomax) therapy in the United States, suggests an analysis of pharmaceutical claims from more than 50 private health plans.

Boston-Urologists are no longer the primary initiators of tamsulosin (Flomax) therapy in the United States, suggests an analysis of pharmaceutical claims from more than 50 private health plans.

Furthermore, the indications for tamsulosin appear to be expanding as a significant percentage of new prescriptions are being written for women and for reasons other than the treatment of BPH.

Bruce Kava, MDThese findings were among those discovered in an evaluation of utilization trends and prescribing patterns associated with tamsulosin. The analysis was presented by Bruce Kava, MD, at the AUA annual meeting in Boston.

“The latest trends are that primary care physicians and emergency room doctors are prescribing alpha-blockers at increasing rates,” Dr. Kava, professor of urology, University of Miami, told Urology Times. “Based on our data, urologists are no longer the primary point for the prescription of tamsulosin.”

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Tamsulosin is the most widely prescribed alpha-blocker for the treatment of lower urinary tract symptoms attributable to BPH, but alpha-blockers are increasingly being used in patients with urolithiasis, prostatitis, and even female voiding dysfunction. As the primary gatekeepers for the medical management of BPH, urologists had been responsible for most alpha-blocker prescriptions.

“The off-label use of tamsulosin has grown tremendously, as 20% of the dispensations for tamsulosin are for female patients,” Dr. Kava said.

He and colleagues examined the PharMetrics Plus database of pharmaceutical claims for 70 million insured patients from more than 55 health plans. They assessed patient and provider characteristics associated with dispensation of tamsulosin during an 18-month period between 2012 and 2013. Patients included were continuously enrolled in the health plan for 12 months before the tamsulosin index date to 6 months after the index date. During this period, 133,997 patients received prescriptions for tamsulosin, of whom 72,583 were new users.

Of the new users, 81.6% were men and 18.4% were women. Most new users (62.1%) were 45 to 64 years of age. Almost 60% of men who were new users of tamsulosin did not have a BPH diagnosis code at any time during the 18 months. Of the 40,000 men without a BPH diagnosis code in the 12 months pre-index period, only 13% received a BPH code in the 6-month post-index period. The largest population of male new tamsulosin users was 55 to 64 years of age for both men with (16%) or without (17%) a diagnosis code for BPH.

New tamsulosin users without a BPH diagnosis code (both men and women) had an average of 1.5 dispensations compared with an average of three dispensations for men with a BPH diagnosis code.

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PCPs prescribe drug more

Among the male new tamsulosin users, primary care physicians initiated 31.6% of tamsulosin prescriptions, urologists initiated 18.0%, and emergency medicine physicians initiated 11.5%.

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Some 85.3% of male new tamsulosin users had at least one targeted comorbidity in the 12 months before tamsulosin initiation. These targeted comorbidities were hypertension in 44.8%, dyslipidemia in 41.2%, kidney stones in 31.9%, heart disease in 17.4%, and diabetes in 16.5%.

“Tamsulosin has been used for the treatment of stones to increase the spontaneous stone passage rate, and the community of medical practitioners has taken this on,” said Dr. Kava. “Certainly, a lot of investigation needs to be done into the use for female voiding disorders and for urolithiasis.”

A credentialing process to ensure appropriate tamsulosin use by non-urologists may be beneficial, he believes.

“I’m not aware of any curriculum that primary care doctors have to take to show a mastery of urologic problems,” Dr. Kava said. “I am working with the American Society of Men’s Health to develop a curriculum for men’s health issues, and certainly that can be adopted by primary care physicians, emergency room doctors, and urologists.”

One of Dr. Kava’s co-authors is an employee of Boehringer-Ingelheim, and another co-author is an investigator for that company. Another co-author is an investigator for Ixchelsis Ltd.