DOCSLIB.ORG

An Evidence-Based Approach to Understanding the Pharmacological Class Effect in the Management of Prostatic Diseases

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
An Evidence-Based Approach to Understanding the Pharmacological Class Effect in the Management of Prostatic Diseases Blackwell Science, LtdOxford, UKBJUBJU International1464-410XBJU InternationalApril 2005 956 Review Article PHARMACOLOGICAL CLASS EFFECT IN MANAGING PROSTATIC DISEASES EVANS et al. An evidence-based approach to understanding the pharmacological class effect in the management of prostatic diseases CHRISTOPHER P. EVANS, NEIL FLESHNER*, JOHN M. FITZPATRICK† and ALEXANDER R. ZLOTTA‡ University of California, Sacramento, CA, USA, *Princess Margaret Hospital, Toronto, Canada; †Mater Hospital and Conway Institute, University College, Dublin, Ireland and ‡University Clinics of Brussels, Erasme Hospital, Brussels, Belgium Accepted for publication 5 December 2004 KEYWORDS reviews or meta-analyses of well-designed Questions have been raised as to whether randomized controlled trials (RCTs), followed study sponsorship may also introduce bias evidence-based medicine, class effect, benign by individual RCTs and well-designed non- and there are concerns that the process of prostatic hyperplasia, prostate cancer randomized studies are considered the most publication itself can lead to bias in favour of robust, reliable and therefore valuable [3]. Less positive results. robust evidence from case reports, clinical INTRODUCTION examples, or consensus meetings may also be Although many clinical trials are conducted considered. ‘blind’ to minimize observer bias, this is not Ever more alternative products are available always a realistic option. For example, in for each drug type commonly used to treat Systematic reviews integrate otherwise prostate cancer trials, it would not be prostatic diseases, i.e. a-blockers, 5a- unmanageable amounts of information from reasonable to carry out sham orchidectomy or reductase inhibitors, antiandrogens and LHRH primary investigations in a way that limits radiotherapy, and characteristic treatment agonists. Once a urologist has decided which bias and random error; meta-analyses allow effects, such as hot flushes with LHRH type of drug to use, their decision about an evaluation of consistency of findings and, agonists, can effectively ‘un-blind’ a study. which specific agent to prescribe will depend if quantitative, may increase the accuracy The more patients in a trial, the more on several factors, including dosing regimen, of estimates of treatment effects [4]. As accurately the size of a clinical effect can be delivery mechanism, speed of onset, such, both should be useful tools in clinical assessed and the less likely the result is to be treatment costs, local prescribing habits, decision-making. However, systematic a result of random chance. The amount of marketing, patient choice, personal reviews and meta-analyses are not always information needed to avoid an incorrect experience and published reports. Ideally, possible. For trials to be combined in a conclusion depends on the size of the effect evidence-based medicine (EBM) should be the systematic review or meta-analysis, there being studied and the level of certainty main factor in treatment choice. This review needs to be a sufficient number of similar required. To be valid, a trial must be of an sets out the principles of EBM and examines studies, i.e. with analogous study designs appropriate design to answer the question the best available evidence for drugs that are in patients with similar disease states and addressed; validity is based on criteria such as commonly prescribed to treat BPH or prostate assessing comparable clinically relevant use of clinically important outcomes and cancer. We consider whether a class effect can outcomes. duration of intervention and observation. be shown for any of these groups of drugs and if class effects should be accepted in Whether trials are combined in a systematic clinical practice. We focus on efficacy, but review or meta-analysis, or examined for their IS THE CLASS EFFECT EVIDENCE-BASED? tolerability can also be an important factor individual merit, their design, endpoints and when choosing between drugs of the same reporting quality need careful examination Drugs are generally considered to be in the class, and will be discussed where relevant. to determine the most appropriate and same class if they have a similar chemical robust data. Trials must be of a high quality structure and mechanism of action, and if to avoid bias, sufficiently large enough to give they confer similar pharmacological effects. PRINCIPLES OF EBM a reliable answer, of good validity, and the However, compounds with very similar population studied should allow the results to structures can have different properties. EBM has been described as the ‘conscientious, be clinically applicable. For example, dihydrotestosterone differs from explicit and judicious use of current best testosterone by only one hydrogen atom, evidence in making decisions about the care One of the most important factors is but has a much greater binding affinity for of individual patients’ [1]. For the clinician, randomization to exclude selection bias; it has the androgen receptor, resulting in different this means identifying the best available been estimated that not randomizing can lead effects on gene expression. Consequently, the evidence from a vast number of published to an overestimation of treatment effect by notion of a pharmacological ‘class effect’ medical reports, assessing whether it is 40% [5]. Other factors (and their percentage should be considered with caution. Indeed, applicable to the individual patient and then overestimation) include small trials (30%), there is no universally accepted definition. using it in clinical practice [2]. Of the types of poor reporting quality (25%), duplicate A class effect is usually taken to mean that published evidence available, systematic reporting (20%), and lack of blinding (17%). drugs in a class have similar therapeutic © 2005 BJU INTERNATIONAL | 95, 743–749 | doi:10.1111/j.1464-410X.2005.05390.x 743 EVANS ET AL. effects and similar safety and tolerability, includes tamsulosin, terazosin, alfuzosin, compared and no definitive conclusions can both in nature and extent [3]. If such a class doxazosin and prazosin, which have different currently be drawn about any differences effect exists, it would be likely that the least selectivity for the a1-adrenoceptor subtypes. between them. While dutasteride is said to costly agent in each class would be the first Systematic reviews have been published for inhibit serum 5a-reductase to a greater choice. However, it is clear that no matter how tamsulosin and terazosin, and a pooled extent than finasteride, the significance of strong the pathophysiological rationale or analysis for alfuzosin (Table 1) [6–8]. These this may be limited, as it is prostatic stromal indirect evidence, the efficacy and safety of a reports, in agreement with an earlier meta- intracellular 5a-reductase that mediates gene new drug must be established in clinical analysis by Djavan and Marberger [9], transcription for growth factor genes. outcome studies, and the equivalency of conclude that the a-blockers are effective Therefore, although the data support the untested drugs even in a well-established and consistently improve LUTS and urinary efficacy of both finasteride and dutasteride in ‘class’ should be considered unconfirmed. flow compared with placebo. BPH, there is as yet insufficient evidence to address the question of whether a class effect For some products routinely used in prostate a-Blockers have been directly compared in a exists for the 5a-reductase inhibitors. medicine, comparative data are limited, but few small trials (involving 50–256 patients) prescription is still widespread based on the [9–12]. A review of trials directly comparing a-BLOCKERS COMBINED WITH assumption of a class effect. To take an tamsulosin with terazosin found that these 5a-REDUCTASE INHIBITORS evidence-based approach to establishing a agents are equally effective in improving class effect, RCTs of direct comparisons of symptoms [7,8]. No definitive conclusions The long-term efficacy of the a-blocker drugs within the class are needed [3]. about differences in efficacy can be made doxazosin and the 5a-reductase inhibitor However, this level of evidence is rarely from these studies; all a-blockers, whether finasteride, as monotherapy or combined, was available. selective or not, seem to have similar efficacy evaluated in a randomized, long-term, in short-term trials [9]. The data suggest that double-blind placebo-controlled trial [15]. The next best level of evidence includes a1-blockers, such as terazosin or doxazosin, While each agent reduced the risk of overall indirect comparisons across two or more give similar improvements as subtype- clinical progression, combined therapy was placebo-controlled trials. In this case, only selective a1a-blockers, like tamsulosin, in peak significantly more effective than either proportional effects such as the relative risk urinary flow rates and symptom scores after monotherapy. This trial was of excellent reduction can be compared. A class effect is 4 weeks of treatment. From these studies it design, yet raises several interesting issues considered to be present when drugs with might be concluded, on the basis of efficacy, about the class effect. For example, is it similar mechanisms of action generate that there possibly is a class effect. However, appropriate to extrapolate the role of relative risk reductions (or odds ratios) that there are differences in tolerability, with doxazosin to other a-blockers? The trial are similar in direction and magnitude [3]. tamsulosin better tolerated
Load more

Recommended publications
  • Nonsurgical Hair Restoration Treatment
    COSMETIC DERMATOLOGY Nonsurgical Hair Restoration Treatment Roya S. Nazarian, BA; Aaron S. Farberg, MD; Peter W. Hashim, MD, MHS; Gary Goldenberg, MD androgenic alopecia (AGA).3 Currently, minoxidil and PRACTICE POINTS finasteride are the only US Food and Drug Administration • Hair loss is a common phenomenon in both men (FDA)–approved medications for the treatment of hair and women and can seriously impact psychosocial loss; however, other nonsurgical treatment options have functioning. gained popularity, including dutasteride, spironolactone, • There are numerous US Food and Drug Administration– low-level laser therapy (LLLT), platelet-rich plasma (PRP), approved and off-label nonsurgical treatment options microneedling, stemcopy cells, and nutraceutical supplements. for alopecia. Dermatologists should be well versed in We provide an overview of these treatment options to these treatment modalities and the associated side- help dermatologists select appropriate therapies for the effect profiles to select the appropriate therapy for treatment of alopecia (Table). each patient. Minoxidilnot Minoxidil has been known to improve hair growth for more than 40 years. Oral minoxidil was first introduced Patterned hair loss is common and can negatively impact quality of for hypertension in the 1970s with a common adverse life. Patients often seek nonsurgical treatment options as a first-lineDo measure to avoid undue risks and expense associated with surgery. effect of hypertrichosis; the 2% solution was marketed for 4 This article discusses these noninvasive treatment options, with a AGA shortly thereafter in 1986. Minoxidil is a biologic focus on minoxidil, finasteride, dutasteride, spironolactone, low-level response modifier that is thought to promote hair growth laser therapy (LLLT), platelet-rich plasma (PRP), microneedling, and through vasodilation and stimulation of hair follicles into oral supplements.
    [Show full text]
  • Health Risks Associated with Long-Term Finasteride and Dutasteride Use: It’S Time to Sound the Alarm
    Review Article Health promotion, disease prevention, and lifestyle pISSN: 2287-4208 / eISSN: 2287-4690 World J Mens Health 2020 Jul 38(3): 323-337 https://doi.org/10.5534/wjmh.200012 Health Risks Associated with Long-Term Finasteride and Dutasteride Use: It’s Time to Sound the Alarm Abdulmaged M. Traish Department of Urology, Boston University School of Medicine, Boston, MA, USA 5α-dihydrotestosterone (5α-DHT) is the most potent natural androgen. 5α-DHT elicits a multitude of physiological actions, in a host of tissues, including prostate, seminal vesicles, hair follicles, skin, kidney, and lacrimal and meibomian glands. How- ever, the physiological role of 5α-DHT in human physiology, remains questionable and, at best, poorly appreciated. Recent emerging literature supports a role for 5α-DHT in the physiological function of liver, pancreatic β-cell function and survival, ocular function and prevention of dry eye disease and kidney physiological function. Thus, inhibition of 5α-reductases with finasteride or dutasteride to reduce 5α-DHT biosynthesis in the course of treatment of benign prostatic hyperplasia (BPH) or male pattern hair loss, known as androgenetic alopecia (AGA) my induces a novel form of tissue specific androgen deficien- cy and contributes to a host of pathophysiological conditions, that are yet to be fully recognized. Here, we advance the con- cept that blockade of 5α-reductases by finasteride or dutasteride in a mechanism-based, irreversible, inhabitation of 5α-DHT biosynthesis results in a novel state of androgen deficiency, independent of circulating testosterone levels. Finasteride and dutasteride are frequently prescribed for long-term treatment of lower urinary tract symptoms in men with BPH and in men with AGA.
    [Show full text]
  • Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals
    Journal of Clinical Medicine Review Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals Carlotta Cocchetti 1, Jiska Ristori 1, Alessia Romani 1, Mario Maggi 2 and Alessandra Daphne Fisher 1,* 1 Andrology, Women’s Endocrinology and Gender Incongruence Unit, Florence University Hospital, 50139 Florence, Italy; [email protected] (C.C); jiska.ristori@unifi.it (J.R.); [email protected] (A.R.) 2 Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, 50139 Florence, Italy; [email protected]fi.it * Correspondence: fi[email protected] Received: 16 April 2020; Accepted: 18 May 2020; Published: 26 May 2020 Abstract: Introduction: To date no standardized hormonal treatment protocols for non-binary transgender individuals have been described in the literature and there is a lack of data regarding their efficacy and safety. Objectives: To suggest possible treatment strategies for non-binary transgender individuals with non-standardized requests and to emphasize the importance of a personalized clinical approach. Methods: A narrative review of pertinent literature on gender-affirming hormonal treatment in transgender persons was performed using PubMed. Results: New hormonal treatment regimens outside those reported in current guidelines should be considered for non-binary transgender individuals, in order to improve psychological well-being and quality of life. In the present review we suggested the use of hormonal and non-hormonal compounds, which—based on their mechanism of action—could be used in these cases depending on clients’ requests. Conclusion: Requests for an individualized hormonal treatment in non-binary transgender individuals represent a future challenge for professionals managing transgender health care. For each case, clinicians should balance the benefits and risks of a personalized non-standardized treatment, actively involving the person in decisions regarding hormonal treatment.
    [Show full text]
  • Gender-Affirming Hormone Therapy
    GENDER-AFFIRMING HORMONE THERAPY Julie Thompson, PA-C Medical Director of Trans Health, Fenway Health March 2020 fenwayhealth.org GOALS AND OBJECTIVES 1. Review process of initiating hormone therapy through the informed consent model 2. Provide an overview of masculinizing and feminizing hormone therapy 3. Review realistic expectations and benefits of hormone therapy vs their associated risks 4. Discuss recommendations for monitoring fenwayhealth.org PROTOCOLS AND STANDARDS OF CARE fenwayhealth.org WPATH STANDARDS OF CARE, 2011 The criteria for hormone therapy are as follows: 1. Well-documented, persistent (at least 6mo) gender dysphoria 2. Capacity to make a fully informed decision and to consent for treatment 3. Age of majority in a given country 4. If significant medical or mental health concerns are present, they must be reasonably well controlled fenwayhealth.org INFORMED CONSENT MODEL ▪ Requires healthcare provider to ▪ Effectively communicate benefits, risks and alternatives of treatment to patient ▪ Assess that the patient is able to understand and consent to the treatment ▪ Informed consent model does not preclude mental health care! ▪ Recognizes that prescribing decision ultimately rests with clinical judgment of provider working together with the patient ▪ Recognizes patient autonomy and empowers self-agency ▪ Decreases barriers to medically necessary care fenwayhealth.org INITIAL VISITS ▪ Review history of gender experience and patient’s goals ▪ Document prior hormone use ▪ Assess appropriateness for gender affirming medical
    [Show full text]
  • Basics of Hormone Therapy for Transgender Patients Julie K
    Basics of Hormone Therapy for Transgender Patients Julie K. Prussack, MD Northern Michigan Family Medicine Update June 27, 2019 Disclosures None Disclaimer: No medications are currently FDA-approved for gender alteration or affirmation. Discussion of treatment is based on expert opinion. Objectives 1. Understand the difference between informed consent and referral letter models for initiating hormone therapy. 2. Access UCSF Guidelines for the Primary and Gender- Affirming Care of Transgender and Gender Nonbinary People. 3. Understand the medications, routes, and doses typically used for feminizing and masculinizing therapy. 4. Understand typical expectations and monitoring for patients on feminizing or masculinizing therapy. Hormone Therapy • Goal to suppress endogenous hormones by providing exogenous hormones • Affects secondary sex characteristics • Masculinizing: testosterone • Feminizing: estrogen, anti-androgen, ?progesterone • Patients may desire surgery of body contours and genitalia • Referral letter vs. informed consent models Stroumsa et al. Gender affirming treatment ant transition-related care. URL: https://www.youtube.com/watch?v=3ixr0YgB0As WPATH • Incorporated in 1979 as the Harry Benjamin International Gender Dysphoria Association, changed name to World Professional Association for Transgender Health in 2007 • 7th version of Standards of Care (SOC) published in 2012 • Mission to promote evidence based care, education, research, advocacy, public policy, and respect in transgender health. World Professional Association for Transgender Health, 2016. URL: www.wpath.org WPATH Criteria for Hormone Therapy 1. Persistent, well-documented gender dysphoria 2. Capacity to make a fully informed decision and to consent for treatment 3. Age of majority in a given country (if younger, follow SOC for Puberty-Suppressing Hormones) 4. If significant medical or mental health concerns are present, they must be reasonably well-controlled.
    [Show full text]
  • Risk of Depression After 5 Alpha Reductase Inhibitor Medication: Meta-Analysis
    Original Article Prostate and male voiding dysfunctions pISSN: 2287-4208 / eISSN: 2287-4690 World J Mens Health Published online May 23, 2019 https://doi.org/10.5534/wjmh.190046 Risk of Depression after 5 Alpha Reductase Inhibitor Medication: Meta-Analysis Jae Heon Kim1,2 , Sung Ryul Shim3,4 , Yash Khandwala1 , Francesco Del Giudice5 , Simon Sorensen6 , Benjamin I. Chung1 1Department of Urology, Stanford University Medical Center, Stanford, CA, USA, 2Department of Urology and 3Urological Biomedicine Research Institute, Soonchunhyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, 4Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea, 5Department of Urology, Sapienza University of Rome, Rome, Italy, 6Department of Urology, Aarhus University Hospital, Aarhus, Denmark Purpose: Although five-alpha reductase inhibitor (5-ARI) is one of standard treatment for benign prostatic hyperplasia (BPH) or alopecia, potential complications after 5-ARI have been issues recently. This study aimed to investigate the risk of depres- sion after taking 5-ARI and to quantify the risk using meta-analysis. Materials and Methods: A total of 209,940 patients including 207,798 in 5-ARI treatment groups and 110,118 in control groups from five studies were included for final analysis. Inclusion criteria for finial analysis incudes clinical outcomes re- garding depression risk in BPH or alopecia patients. Overall hazard ratio (HR) and odds ratio (OR) for depression were ana- lyzed. Moderator analysis and sensitivity analysis were performed to determine whether HR or OR could be affected by any variables, including number of patients, age, study type, and control type. Results: The pooled overall HRs for the 5-ARI medication was 1.23 (95% confidence interval [CI], 0.99–1.54) in a random effects model.
    [Show full text]
  • Endocrine Therapy for Transgender Youth
    Endocrine Therapy for Transgender Youth Daniel L. Metzger, MD www.transyouthla.com Normal puberty girls breast development starts at 10 (8–12) growth spurt peak at 11½ (9½–12½) first period at 12½ (10½–14½) boys testicular enlargement starts at 11 (9–13) growth spurt peak at 13½ (11½–15½) considerable variability The overarching treatment goal “The general goal of psychotherapeutic, endocrine, or surgical therapy for persons with gender identity disorders is lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment.” WPATH Standards of Care, 6th version Why treat kids under age 18? studies show less post-operative function is related to the “ability to pass” physical outcomes much better if patient treated before breast development, beard growth, deepening of the voice prevent developmental problems related to discrepancy between body and mind patients are suffering! How are kids different? still growing still accruing bone-mineral content still going through the physical changes of puberty still going through the psychological and developmental changes of puberty their GID may not be as “solidified” they have to deal with the school system Our approach to treating youth different from treating adults more of an attempt to mirror natural puberty therefore, end results appear more gradually use available guidelines and published experience (Netherlands!) WPATH Standards of Care, 6th version Vancouver Coastal Health, Transgender Health Program Endocrine Society CPG: Endocrine
    [Show full text]
  • Pharmacologic Basis for the Enhanced Efficacy of Dutasteride Against Prostatic Cancers Yi Xu, Susan L
    Cancer Therapy: Preclinical Pharmacologic Basis for the Enhanced Efficacy of Dutasteride against Prostatic Cancers Yi Xu, Susan L. Dalrymple, Robyn E. Becker, Samuel R. Denmeade, andJohn T.Isaacs Abstract Purpose: Prostatic dihydrotestosterone (DHT) concentration is regulated by precursors from systemic circulation and prostatic enzymes of androgen metabolism, particularly 5a-reductases (i.e., SRD5A1 and SRD5A2). Therefore, the levels of expression SRD5A1 and SRD5A2 and the antiprostatic cancer growth response to finasteride, a selective SRD5A2 inhibitor, versus the dual SRD5A1and SRD5A2 inhibitor, dutasteride, were compared. Experimental Design: Real-time PCR and enzymatic assays were used to determine the levels of SRD5A1and SRD5A2 in normal versus malignantratand human prostatic tissues. Ratsbearing the Dunning R-3327H rat prostate cancer and nude mice bearing LNCaP or PC-3 human prostate cancer xenografts were used as model systems. Tissue levels of testosterone and DHT were determined using liquid chromatography-mass spectrometry. Results: Prostate cancer cells express undetectable to low levels of SRD5A2 but elevated levels of SRD5A1activity compared with nonmalignant prostatic tissue. Daily oral treatment of rats with the SRD5A2 selective inhibitor, finasteride, reduces prostate weight and DHTcontent but did not inhibit R-3327Hrat prostate cancer growth or DHTcontent in intact (i.e., noncastrated) male rats. In contrast, daily oral treatment with even a low1mg/kg/d dose of the dual SRD5A1and SRD5A2 inhibitor, dutasteride, reduces both normal prostate and H tumor DHTcontent and weight in intact rats while elevating tissue testosterone. Daily oral treatment with finasteride significantly (P < 0.05) inhibits growth of LNCaP human prostate cancer xenografts in intact male nude mice, but this inhibition is not as great as that by equimolar oral dosing with dutasteride.This anticancer efficacy is not equivalent, however, to that produced by castration.
    [Show full text]
  • An Analysis on Whether Or Not Baldness Can Be Reversed
    The Science Journal of the Lander College of Arts and Sciences Volume 10 Number 2 Spring 2017 - 2017 An Analysis on Whether or Not Baldness Can Be Reversed Spencer Waldman Touro College Follow this and additional works at: https://touroscholar.touro.edu/sjlcas Part of the Integumentary System Commons Recommended Citation Waldman, S. (2017). An Analysis on Whether or Not Baldness Can Be Reversed. The Science Journal of the Lander College of Arts and Sciences, 10(2). Retrieved from https://touroscholar.touro.edu/sjlcas/ vol10/iss2/11 This Article is brought to you for free and open access by the Lander College of Arts and Sciences at Touro Scholar. It has been accepted for inclusion in The Science Journal of the Lander College of Arts and Sciences by an authorized editor of Touro Scholar. For more information, please contact [email protected]. An Analysis on Whether or not Baldness can be Reversed Spencer Waldman Spencer Waldman will graduate with a BS in Biology in September 2017. Abstract Many men experiencing hair loss often wonder: is there a cure? Can I get my hair regrown? This thesis addresses these very issues, the anatomy of the pilosebaceous hair, the hair growth cycle, and the suggested causes of male male pattern hair loss are examined. Finally, the Various drugs that have been suggested to reduce hair loss and even cause hair regrowth are reviewed. After examining the various treatments, it can be concluded with reasonable certainty that hair loss can be halted and often reversed by using FDA approved drugs finasteride and minoxidil.
    [Show full text]
  • Hormonal Therapies for Hidradenitis Suppurativa: Review
    Volume 23 Number 10 | October 2017 Dermatology Online Journal || Review DOJ 23 (10): 1 Hormonal therapies for hidradenitis suppurativa: Review Ashley K Clark1 BS, Rebecca L Quinonez2 BS, Suzana Saric1 BA, Raja K Sivamani3,4 MD MS CAT Affiliations:1 School of Medicine, University of California, Davis, Sacramento, California, 2School of Medicine, Universidad Autonoma de Guadalajara - San Antonio, Texas, 3Department of Dermatology, University of California, Davis, Sacramento, California, 4Department of Biological Sciences, California State University-Sacramento, Sacramento, California Corresponding Author: Raja Sivamani MD, MS, CAT, Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA 95816, Tel: 916-703-5145, Fax: 916-734-7183, Email: [email protected] Abstract of the surrounding tissue [2]. Abscess formation is commonly seen and it can extend deep into the Hidradenitis suppurativa is a recurrent inflammatory subcutaneous tissue, further promoting deep sinus skin condition characterized by abscesses and boils, tract formation. Hypertrophic scarring is a common predominantly in the groin, armpit, and buttocks sequela of the condition, primarily affecting those areas. HS is not a life-threatening condition, but with darker skin tones. severely impairs quality of life in those affected. Finding a successful treatment approach for HS has Clinically HS presents as painful papules and nodules, been challenging, in part because of the lack of a gold- eventually progressing to abscess formation and standard treatment method, limited research-based severe scarring. It may also be characterized by information, and the nature of clinical variation in the having a malodorous sterile discharge. The severity of disease. Treatment commonly consists of antibiotics, the disease is described by the Hurley stages.
    [Show full text]
  • Efficacy and Tolerability of the Dual 5A-Reductase Inhibitor, Dutasteride, in the Treatment of Benign Prostatic Hyperplasia in African-American Men
    Prostate Cancer and Prostatic Diseases (2006) 9, 432–438 & 2006 Nature Publishing Group All rights reserved 1365-7852/06 $30.00 www.nature.com/pcan ORIGINAL ARTICLE Efficacy and tolerability of the dual 5a-reductase inhibitor, dutasteride, in the treatment of benign prostatic hyperplasia in African-American men CG Roehrborn1 and P Ray2 1Department of Urology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA and 2Division of Urology, Cook County Hospital, Chicago, IL, USA The efficacy and tolerability of dutasteride (0.5 mg daily for 2 years) in African-Americans (n ¼ 161), compared with Caucasians (n ¼ 3961), was assessed in a post hoc analysis of data from three Phase III clinical trials. Dutasteride significantly reduced serum dihydrotestosterone levels by 490% and significantly improved subjective (symptom score) and objective (prostate volume, peak urinary flow rate, risk of benign prostatic hyperplasia-related surgery and acute urinary retention) outcomes in both African-Americans and Caucasians. For all efficacy measures, there was no statistically significant treatment-by-race interaction and dutasteride was well tolerated in both racial groups. Therefore, dutasteride demonstrated similar efficacy and safety profiles in African- Americans and Caucasians. Prostate Cancer and Prostatic Diseases (2006) 9, 432–438. doi:10.1038/sj.pcan.4500911; published online 19 September 2006 Keywords: benign prostatic hyperplasia; African-American men; dutasteride Introduction prostate-specific antigen (PSA) levels.18,19 Cultural fac- tors – such as the tendency to report symptoms – and Benign prostatic hyperplasia (BPH) is one of the most behavioural factors – for example, diet – may also 1 common diseases of ageing men, affecting more than contribute to racial differences in the incidence and 50% of men in their sixties and 90% of men over the age progression of BPH.
    [Show full text]
  • Androgens in Women: Hormone-Modulating Therapies For
    Androgens in women Hormone-modulating therapies for skin disease Sarah Azarchi, BS,a Amanda Bienenfeld, BA,a Kristen Lo Sicco, MD,b ShariMarchbein,MD,b Jerry Shapiro, MD,b and Arielle R. Nagler, MDb New York, New York Learning objectives After completing this learning activity, participants should be able to list, categorize, and explain the mechanisms of action, safety considerations, and contraindications of these androgen-modulating therapies; identify the hormone-modulating therapies used to treat acne, hirsutism, and androgenetic alopecia; and describe the evidence to support the efficacy of these therapies in the treatment of acne, hirsutism, and androgenetic alopecia. Disclosures Editors The editors involved with this CME activity and all content validation/peer reviewers of the journal-based CME activity have reported no relevant financial relationships with commercial interest(s). Authors The authors involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s). Dr Shapiro is a stockholder in Replicel Life Sciences and has been a consultant for Aclaris, Samumed, Incyte, Bioniz, keeps.com, Applied Biology, and Pfizer. Planners The planners involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s). The editorial and education staff involved with this journal-based CME activity have reported no relevant financial relationships with commercial interest(s). Androgen-mediated cutaneous disorders (AMCDs) in women, including acne, hirsutism, and female pattern hair loss, can be treated with hormone-modulating therapies. In the second article in this Continuing Medical Education series, we discuss the hormone-modulating therapies available to dermatologists for the treatment of AMCDs, including combined oral contraceptives, spironolactone, finasteride, dutasteride, and flutamide.
    [Show full text]