AUA2013：75%勃起障碍患者未接受治疗

　　圣迭戈——伊利诺伊州北岸大学医学院的Brian T. Helfand医生在美国泌尿外科学会(AUA)2013年会上报告，在获得ICD-9勃起功能障碍诊断的男性患者中，仅有25%接受了针对这一疾病的治疗。

　　Helfand医生及其合作者使用IMS的数据集，识别出在截至2011年7月的12个月内获得ICD-9勃起功能障碍(ED)诊断的6,228,509例年龄超过30岁的男性患者。IMS是一个大型保险索赔数据集，包含美国80%以上的处方数据。如患者接受了5型磷酸二酯酶抑制剂(PDE5)处方治疗、注射或尿道使用前列腺素或接受雄激素替代治疗，则将其归类为已接受治疗；如患者获得ED诊断，但在研究期间未接受处方治疗，则将其归类为未经治疗。研究者根据处方频率、年龄、合并疾病和治疗医生专长来监测治疗情况。

　　结果显示，接受处方治疗的男性患者仅占25%。最常见的处方药物为PDE5(75%)，其次为雄激素替代治疗(31%)。不到2%的患者接受了任何形式的前列腺癌治疗。“最高年龄组的男性接受处方治疗的可能性最低。”低睾酮水平患者接受治疗的频率较高(51%接受治疗)，前列腺癌患者接受治疗的频率较低(15%接受治疗)。其他相关合并疾病患者的治疗频率无显著差异。

　　总体上，最大比例的处方是由基层医生开具的(28%)，其次为内分泌科医生(27%)和泌尿外科医生(21%)。其他24%的处方是由其他专业的医生开具的。

　　研究者总结认为，在获得ED诊断的男性中仅有25%接受了任何形式的治疗。由于ED常伴发其他疾病，因此ED治疗不足提示对于伴发的其他疾病也存在诊治不足。

　　Helfand医生报告称无相关利益冲突。合著者之一Kevin McVary医生承认担任一些医药公司的顾问或其他职务，涉及爱力根、礼来、NxThera、Watson、NeoTract和葛兰素史克公司。

Erectile dysfunction: 75% with diagnosis go untreated
SAN DIEGO – Of men given an ICD-9 diagnosis of erectile dysfunction, 25% receive any treatment for the condition.
Treatment frequency was higher in men who had low levels of testosterone (51% treated) and lower in those who had prostate cancer (15% treated). Treatment frequency did not vary significantly with other associated comorbidities, Dr. Brian T. Helfand said in a press briefing at the annual meeting of the American Urological Association.
Dr. Helfand of the department of urology at NorthShore University Health System in Evanston, Ill., and his associates used an IMS data set to identify 6,228,509 men over the age of 30 years who received an ICD-9 diagnosis of erectile dysfunction (ED) during a 12-month period that ended in July 2011. IMS is a large insurance claims data set that encompasses more than 80% of prescription data in the United States.
Men were classified as treated if they filled a prescription for a phosphodiesterase type-5 (PDE5) inhibitor, injection or urethral prostaglandins, or androgen replacement therapy. They were classified as untreated if they received an ED diagnosis but did not fill a prescription in the study period. The researchers monitored the therapies by prescription frequency, age, comorbidities, and physician specialty.
Among the 25% of men who filled prescriptions, PDE5 was the most commonly prescribed medication (75%), followed by androgen replacement therapy (31%). Fewer than 2% of patients used any prostaglandin therapy. "The men who were in the oldest age groups were the least likely to fill a prescription," Dr. Helfand said.
The greatest proportion of prescriptions overall were ordered by primary care physicians (28%), followed by endocrinologists (27%), and urologists (21%). The remaining 24% were ordered by various other clinicians.
Dr. Helfand said limitations of the study include the exclusion of Medicare data plus lack of information about the severity of ED, efficacy of treatments, and adherence to long-term therapy.
Dr. Ajay Nangia, who is an associate professor of urology at the University of Kansas Medical Center and the moderator of the press briefing, noted that ED is a medical disease that is often a portent of other disorders. Recognizing that men with ED go untreated may mean that they’re also possibly underinvestigated for associated condition such as diabetes, lipid disorders, and risk factors such as smoking.
Dr. Helfand said that he had no relevant financial conflicts to disclose. One of the study authors, Dr. Kevin McVary, disclosed consultant, advisory, or other roles with several companies, including Allergan, Lilly, NxThera, Watson, NeoTract, and GSK.