Number of people purchasing finasteride prescriptions

General Discussion
#1

I found data about how many people purchased finasteride prescriptions from 2007 - 2017 in the U.S. [1]
2007: 694,000
2008: 1,115,000
2009: 1,065,000
2010: 1,380,000
2011: 1,478,000
2012: 1,440,000
2013: 1,520,000
2014: 1,577,000
2015: 1,759,000
2016: 2,343,000
2017: 2,156,000

We don’t know what percentage of men get adverse effects, but if we assume 3%, that’s 65,000 men in the U.S. This is speculation, but gives an order of magnitude to start with.

[1] US HHS: Agency for Healthcare Research and Quality: Prescribed Drugs
https://meps.ahrq.gov/mepstrends/hc_pmed/

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#2

And that’s just Finasteride. Not even counting Dut, or Accutane, or people that order drugs online without a prescription? I am here because of Minoxidil. There are easily more than 200,000 - 500,000 people in the US alone with post drug syndrome.

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#3

Any idea why there is no data until 2007? Maybe Merck published sales data for its shareholders for these years?

So is this number of people with at least one prescription within the calendar year?

I believe one of the statistical papers by Prof. Belknap quantified the risk of persistent post-finasteride side effects as 35 per 1000 patient years, which means the effect is cumulative - i.e. it increases the longer the drug is taken. How would that change the estimated number of people with PFS?

Also, we should probably triple that number for the worldwide prevalence.

I once did a back of the napkin estimate for PFS morbidity from finasteride of 500,000 globally. I think the order of magnitude is right.

#4

Great points @Zonz and @Sibelio

@Sibelio Missing data means there was inadequate precision in the data, according to AHRQ notes. Yes, the above data is number of people who filled at least one prescription in that year.

You might be able to find Merck’s Propecia/Proscar sales data in Merck SEC filings at edgar.sec.gov (ticker is MRK)

I haven’t seen that estimate from Belknap. I checked the one Belknap paper I know of in JAMA Dermatology and didn’t see that statistic. If you find it let me know.

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#5

Attaching charts I made of AHRQ data.

Finasteride data from AHRQ
Finasteride data from AHRQ2282×1256 190 KB

I’d like to upload the data as a CSV but it looks like I can’t do so in the forum. If you want the data let me know and I’ll send it to you.

The reason cost is going down even as more people buy finasteride is probably that people are shifting from branded to generics.

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#6

I will try to remember where I saw that number. I might be wrong about it but I will look. In the meantime, check out this paper. It has a lot of fancy stats.

Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride

Tina Kiguradze, William H. Temps, […], and Steven M. Belknap

Abstract

Importance

Case reports describe persistent erectile dysfunction (PED) associated with exposure to 5α-reductase inhibitors (5α-RIs). Clinical trial reports and the manufacturers’ full prescribing information (FPI) for finasteride and dutasteride state that risk of sexual adverse effects is not increased by longer duration of 5α-RI exposure and that sexual adverse effects of 5α-RIs resolve in men who discontinue exposure.

Objective

Our chief objective was to assess whether longer duration of 5α-RI exposure increases risk of PED, independent of age and other known risk factors. Men with shorter 5α-RI exposure served as a comparison control group for those with longer exposure.

Design

We used a single-group study design and classification tree analysis (CTA) to model PED (lasting ≥90 days after stopping 5α-RI). Covariates included subject attributes, diseases, and drug exposures associated with sexual dysfunction.

Setting

Our data source was the electronic medical record data repository for Northwestern Medicine.

Subjects

The analysis cohorts comprised all men exposed to finasteride or dutasteride or combination products containing one of these drugs, and the subgroup of men 16–42 years old and exposed to finasteride ≤1.25 mg/day.

Main outcome and measures

Our main outcome measure was diagnosis of PED beginning after first 5α-RI exposure, continuing for at least 90 days after stopping 5α-RI, and with contemporaneous treatment with a phosphodiesterase-5 inhibitor (PDE5I). Other outcome measures were erectile dysfunction (ED) and low libido. PED was determined by manual review of medical narratives for all subjects with ED. Risk of an adverse effect was expressed as number needed to harm (NNH).

Results

Among men with 5α-RI exposure, 167 of 11,909 (1.4%) developed PED (persistence median 1,348 days after stopping 5α-RI, interquartile range (IQR) 631.5–2320.5 days); the multivariable model predicting PED had four variables: prostate disease, duration of 5α-RI exposure, age, and nonsteroidal anti-inflammatory drug (NSAID) use. Of 530 men with new ED, 167 (31.5%) had new PED. Men without prostate disease who combined NSAID use with >208.5 days of 5α-RI exposure had 4.8-fold higher risk of PED than men with shorter exposure (NNH 59.8, all p < 0.002). Among men 16–42 years old and exposed to finasteride ≤1.25 mg/day, 34 of 4,284 (0.8%) developed PED (persistence median 1,534 days, IQR 651–2,351 days); the multivariable model predicting PED had one variable: duration of 5α-RI exposure. Of 103 young men with new ED, 34 (33%) had new PED. Young men with >205 days of finasteride exposure had 4.9-fold higher risk of PED (NNH 108.2, p < 0.004) than men with shorter exposure.

Conclusion and relevance

Risk of PED was higher in men with longer exposure to 5α-RIs. Among young men, longer exposure to finasteride posed a greater risk of PED than all other assessed risk factors.

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#7

That’s a great paper (and full text is available online from that link). The finding is that duration of exposure is the strongest predictor of PED (other than prostate disease or surgery). As I read this, for young men taking finasteride for more than 205 days, about 1% will experience PED. There is more nuance to the way they put it but I think this is roughly it.

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#8

Thank you for posting this. 1-2% of men getting PFS is entirely reasonable and it annoys me when people make wild claims about this being an epidemic that secretly affects hundreds of thousands or millions of people.

#9

2% of 20 million people exposed to Finasteride worldwide is 400,000, although I think more than 20 million have taken finasteride. This truly is an epidemic of enormous proportion, especially considering the severity of the condition, which destroys people’s entire lives and leaves most of them disabled and many dead.

#10

Honest question: where did you get the 20 million number from?

#11

Look at the numbers at the beginning of the thread. Factor in the missing years since 1992. Finasteride has a very high drop-out rate so many of these are not the same people over the years. Then multiply these numbers at least by 3 to get the global consumption - one time for Europe and one time for all the rest of the world. I have also read elsewhere numbers in that ball park.

#12

On top of that we have the people who have PFS from Saw Palmetto. In many countries Saw Palmetto is more popular than finasteride.

Then on top of that we have people with post-accutane sexual dysfunction which in all likelihood is the same condition. Accutane has been on the market since 1982 and tens of millions of people have taken it.

Then on top of that add people with PSSD. Hundreds of millions have taken SSRIs.

The total number of people who have this condition is absolutely in the millions.

Yet, according to evidence based medicine, we don’t exist. (“There is no scientific evidence to establish the existence of a post finasteride syndrome”)

#13

Well, Dr. Goldstein said there could be 300,000 men suffering from PFS, so I may have spoken too soon. I personally don’t feel comfortable trying to speculate how many people are suffering like us, but I won’t try to stop anyone else.

[source for Goldstein quote: https://www.nbcnews.com/health/mens-health/hair-loss-drug-propecia-carries-risk-losing-something-else-n731841]

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#14

@Sibelio we need to draw some lines around what we are estimating. Some things to consider:

  • Of the people taking finasteride, some are taking it for BPH or prostate cancer prevention. These men will tend to be older and less sexually active.

  • Some subset would have taken finasteride for hair loss (AGA), and tend to be younger with more to lose in “sexually active life years” from persistent sexual symptoms. I have no idea what percentage of men are taking finasteride for hair loss vs. BPH or prostate cancer.

I’d like to know how many men took finasteride specifically for AGA, because it is cosmetic and not medically necessary. The risk/benefit calculation is different if you’re facing prostate cancer or BPH compared to hair loss.

P.S. The doctors prescribing finasteride for BPH or prostate cancer will tend to be urologists, while those prescribing for hair loss will tend to be dermatologists or primary care doctors (of course, not always).

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