Session: MP15: Infections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia
MP15-17: Impact of Vaginal Prasterone on the Rate of Urinary Tract Infections in GSM patients and those with a History of Breast Cancer: A Retrospective Cohort Analysis.
Assistant clinical professor in Urology Georgetown University Hospital
Introduction: The Genitourinary Syndrome of Menopause (GSM) is attributed to a decline in the levels of circulating sexual steroids which often results in increased vaginal pH, atrophic urogenital changes, elevated amount of post-void residual urine, and changes in the vaginal microbiome with a shift towards a predominance of fecal gram-negative bacteria rather than lactobacilli, which is believed to create a potential reservoir for recurrent urinary tract infections (UTIs). Current guidelines to prevent recurrent UTIs include vaginal estrogens. Intravaginal prasterone is converted locally in the vaginal tissue into androgens which are subsequently aromatised into estrogens. It is indicated to treat moderate to severe dyspareunia in postmenopausal women in the US. The objective of this study was to assess, through real world evidence data, the potential of vaginal prasterone to be used in postmenopausal GSM women with recurrent UTIs as prophylaxis to reduce the future UTI risk. As a sensitivity analysis, women using aromatase inhibitors, medications that stop the production of estrogen in postmenopausal women typically prescribed to women with a history of breast cancer, were analyzed. Methods: This retrospective matched-cohort study was conducted using the Integrated Dataverse (IDV®) - an open-source claims database from Symphony Health Solutions with data from February 2015 through January 2020. Results: 22,245 women treated with prasterone for a minimum of 12 weeks were matched to women without any prescribed VVA-related treatment. Within each of these two groups, 286 matched patients were taking aromatase inhibitors. Across all age groups, women treated with prasterone have a significantly lower UTI prevalence compared to those untreated (6.58% and 12.3%, respectively; p?0.0001). The highest difference in UTI prevalence among the prasterone treated and untreated women was observed in those aged 65-74 (7.15% and 16.2% respectively; p?0.0001). Consistent with the above, among aromatase inhibitor users, women treated with prasterone have a significantly lower UTI prevalence (4.90% vs. 9.79%; p=0.008). Conclusions: This study suggests that intravaginal prasterone may be a good candidate for prophylaxis in postmenopausal women with recurrent UTIs to reduce future UTI risk, including for patients taking aromatase inhibitors and having contraindications for estrogen-based therapies. This study is however based on real-world evidence and warrants further investigation in a clinical setting. SOURCE OF Funding: Endoceutics
