The results of the study showed that men who received long-acting testosterone undecanoate injections were more adherent to treatment after 1 year than men who received short-acting testosterone propionate injections.
A retrospective analysis of data from more than 122,000 men in the United States showed that men treated with testosterone undecanoate (Aveed, Endo Pharmaceuticals) had similar adherence rates in the first 6 months of treatment as men treated with testosterone cypionate. Adherence rates ranged from 7 to 12 months, with only 8.2% of patients treated with testosterone cypionate continuing treatment for 12 months compared to 41.9% of patients treated with testosterone undecanoate.
“The evidence suggests that more convenient forms of testosterone treatment, such as long-acting injections, are important for the willingness of men with testosterone deficiency to continue treatment,” said Abraham Morgenthaler, MD, assistant professor of surgery. Helio said he worked in the urology department at Beth Israel Deaconess Medical Center at Harvard Medical School. “There is growing recognition that testosterone deficiency is an important health condition and that testosterone therapy can improve not only symptoms but also overall health benefits such as improved blood sugar control, reduced fat mass and increased muscle mass, mood, density bones and an unspecified cause. anemia. However, these benefits can only be realized if men stick to treatment.”
Morgenthaler and colleagues conducted a retrospective cohort study of data from the Veradigm database, which contains electronic health record data from U.S. outpatient facilities, including those who started injectable testosterone undecanoate or testosterone cypionate between 2014 and 2018. Men aged 18 and over. Data collected in 6-month increments as of July 2019. Maintenance therapy was defined as an interval between appointments that did not exceed twice the recommended dosing interval of 20 weeks for testosterone undecanoate or 4 weeks for testosterone cypionate. Treatment adherence was assessed from the date of the first injection to the date of discontinuation, prescription change, or end of the originally prescribed testosterone therapy. Testosterone non-adherence in the testosterone undecanoate group was defined as a gap of more than 42 days between the end date of the first appointment and the start date of the second appointment, or a gap of more than 105 days between future appointments. Non-adherence in the testosterone cypionate group was defined as an interval of more than 21 days between the end of one appointment and the start of the next. The investigators assessed changes in body weight, BMI, blood pressure, testosterone levels, rates of new cardiovascular events, and risk factors from 3 months before the first injection to 12 months after the start of treatment.
The study group consisted of 948 men taking testosterone undecanoate and 121,852 men taking testosterone cypionate. At baseline, 18.9% of men in the testosterone undecanoate group and 41.2% of men in the testosterone cypionate group did not have a diagnosis of hypogonadism. Mean free testosterone at baseline was higher in patients taking testosterone undecanoate compared to those taking testosterone cypionate (65.2 pg/mL vs 38.8 pg/mL; P < 0.001).
During the first 6 months, adherence rates were similar in both groups. Over a period of 7 to 12 months, the testosterone undecanoate group had a higher adherence rate than the testosterone cypionate group (82% vs 40.8%; P < 0.001). Compared to 12 months, a higher proportion of men in the testosterone undecanoate group continued naive testosterone therapy (41.9% vs 0.89.9%; P < 0.001). Men taking testosterone cypionate.
“Surprisingly, only 8.2 percent of men who injected testosterone cypionate continued treatment after 1 year,” Morgenthaler said. “The very low value of the most commonly used testosterone therapy in the United States means that testosterone-deficient men are undertreated.”
Patients treated with testosterone undecanoate had greater mean changes in total testosterone (171.7 ng/dl vs 59.6 ng/dl; P < 0.001) and free testosterone (25.4 pg/ml vs 3.7 pg/ml; P = 0.001). An increase of 12 months compared with patients treated with testosterone cypionate. Testosterone undecanoate showed less variability in total testosterone levels than testosterone cypionate.
At 12 months, mean changes in weight, BMI, and blood pressure were similar between groups. The testosterone undecanoate group had a higher proportion of men with newly diagnosed erectile dysfunction and obesity at follow-up, while the testosterone cypionate group had a higher proportion of men diagnosed with hypertension, congestive heart failure, and chronic pain.
More research is needed to understand why most men who inject testosterone cypionate stop treatment within a year, Morgenthaler says.
“We can assume that in this study, testosterone undecanoate was used in much higher amounts for 12 months due to the convenience of the long-acting drug, but to see if this could be due to other factors (such as cost), aversion to frequent self-treatment injections, lack of significant improvement in symptoms, or other reasons,” Morgenthaler said.
Post time: Jul-05-2023