Use of 5-ARIs Increases Risk for Dementia

USE OF 5α-reductase inhibitors (5-ARIs) for benign prostatic hyperplasia (BPH) and androgenic alopecia increases the risk for dementia and depression, study findings suggest. The risk for dementia, however, observed at the start of treatment diminishes over time, indicating that other factors probably underlie this association.

In a Swedish national registry of 2,236,876 men aged 50 to 90 years, 70,645 (3.2%) initiated finasteride and 8774 (0.4%) initiated dutasteride. Finasteride and dutasteride users had a significant 22% and 10% increased risk of all-cause dementia, a 20% and 28% increased risk of Alzheimer’s disease, a 44% and 31% increased risk of vascular dementia, and a 61% and 68% increased risk of depression, respectively, compared with nonusers. While the risk for depression persisted, the risks of the other neurologic conditions diminished after 4 years, Miguel Garcia-Argibay, PhD, of Örebro University in Sweden, and colleagues reported in JAMA Network Open. At no point was 5-ARI use associated with suicide. ■ free survival (LRFS) compared with PN. An IPW-adjusted restricted mean survival time (RMST) analysis revealed that, within a 100-month window, the PCA group had an LRFS that was 22.7 months shorter than in the PN group, Dr Yanagisawa and colleagues reported in Urologic Oncology.

The IPW-adjusted RMST for metastasis-free, cancer-specific, and overall survival did not differ between the groups.

“Our analyses revealed that PCA has a substantially relevant disadvantage regarding local recurrence in patients with cT1b renal tumors compared to PN,” the authors concluded. “We found no differences in complication rates or renal function preservation rates between the 2 procedures.”

The investigators wrote that their findings suggest that PCA “can be an alternative treatment for elderly, comorbid patients, even those with cT1b renal tumors. ■