Medication Treatment Patterns Among Hypogonadal Men Initiated Topical Testosterone Agents

Presentation Number: OR32-4
Date of Presentation: June 17th, 2013

Michael J Schoenfeld*, Emily F Shortridge, Zhanglin Lin Cui and David Muram
Eli Lilly and Company, Indianapolis, IN

Abstract

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.

 

Disclosure: MJS: Employee, Eli Lilly & Company. EFS: Employee, Eli Lilly & Company. ZLC: Employee, Eli Lilly & Company. DM: Employee, Eli Lilly & Company.