Association of the extent of therapy with prostate cancer in those receiving testosterone therapy in a US commercial insurance claims database

David S. Lopez, Danmeng Huang, Konstantinos K. Tsilidis, Mohit Khera, Stephen B. Williams, Randall J. Urban, Orestis A. Panagiotou, Yong fang Kuo, Jacques Baillargeon, Albert Farias, Trudy Krause

Research output: Contribution to journalArticle

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Abstract

Background: Conflicting evidence remains in the association of testosterone therapy (TTh) with prostate cancer (PCa). This inconsistency maybe due, in part, to the small sample sizes from previous studies and an incomplete assessment of comorbidities, particularly diabetes. Objective: We investigated the association of PCa with TTh (injection or gel) and different TTh doses and determined whether this association varies by the presence of diabetes at baseline in a large, nationally representative, commercially insured cohort. Design: We conducted a retrospective cohort study of 189 491 men aged 40-60 years old in the IBM MarketScan® Commercial Database, which included 1424 PCa cases diagnosed from 2011 to 2014. TTh was defined using CPT codes from inpatient and outpatient, and NDC codes from pharmacy claims. Multivariable adjusted Cox proportional hazards models were used to compute hazard ratios for patients with incident PCa. Results: We found a 33% reduced association of PCa after comparing the highest category (>12) of TTh injections with the lowest (1-2 injections) category (HR = 0.67, 95% CI: 0.54-0.82). Similar statistical significant inverse association for PCa was observed for men who received TTh topical gels (>330 vs 1- to 60-days supply). Among nondiabetics, we found significant inverse association between TTh (injection and gel) and PCa, but a weak interaction between TTh injections and diabetes (P =.05). Conclusion: Overall, increased use of TTh is inversely associated with PCa and this remained significant only among nondiabetics. These findings warrant further investigation in large randomized placebo-controlled trials to infer any health benefit by TTh.

Original languageEnglish (US)
JournalClinical Endocrinology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Insurance
Testosterone
Prostatic Neoplasms
Databases
Therapeutics
Injections
Gels
Current Procedural Terminology
Insurance Benefits
Proportional Hazards Models
Sample Size
Comorbidity
Inpatients
Cohort Studies
Outpatients
Randomized Controlled Trials
Retrospective Studies
Placebos

Keywords

  • health claims data and diabetes
  • prostate cancer
  • testosterone therapy

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Association of the extent of therapy with prostate cancer in those receiving testosterone therapy in a US commercial insurance claims database. / Lopez, David S.; Huang, Danmeng; Tsilidis, Konstantinos K.; Khera, Mohit; Williams, Stephen B.; Urban, Randall J.; Panagiotou, Orestis A.; Kuo, Yong fang; Baillargeon, Jacques; Farias, Albert; Krause, Trudy.

In: Clinical Endocrinology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Conflicting evidence remains in the association of testosterone therapy (TTh) with prostate cancer (PCa). This inconsistency maybe due, in part, to the small sample sizes from previous studies and an incomplete assessment of comorbidities, particularly diabetes. Objective: We investigated the association of PCa with TTh (injection or gel) and different TTh doses and determined whether this association varies by the presence of diabetes at baseline in a large, nationally representative, commercially insured cohort. Design: We conducted a retrospective cohort study of 189 491 men aged 40-60 years old in the IBM MarketScan{\circledR} Commercial Database, which included 1424 PCa cases diagnosed from 2011 to 2014. TTh was defined using CPT codes from inpatient and outpatient, and NDC codes from pharmacy claims. Multivariable adjusted Cox proportional hazards models were used to compute hazard ratios for patients with incident PCa. Results: We found a 33{\%} reduced association of PCa after comparing the highest category (>12) of TTh injections with the lowest (1-2 injections) category (HR = 0.67, 95{\%} CI: 0.54-0.82). Similar statistical significant inverse association for PCa was observed for men who received TTh topical gels (>330 vs 1- to 60-days supply). Among nondiabetics, we found significant inverse association between TTh (injection and gel) and PCa, but a weak interaction between TTh injections and diabetes (P =.05). Conclusion: Overall, increased use of TTh is inversely associated with PCa and this remained significant only among nondiabetics. These findings warrant further investigation in large randomized placebo-controlled trials to infer any health benefit by TTh.",
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AU - Williams, Stephen B.

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AU - Panagiotou, Orestis A.

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