Pharmacotherapy reduces recurrence risk for aggressive stone disease

Pharmacotherapy for reducing risk of stone recurrence is best reserved for patients with more aggressive disease who are at higher risk for another stone-related event, said Brett A. Johnson, MD, at the 2019 World Congress of Endourology and SWL in Abu Dhabi.

His statement was based on the findings of a retrospective study that compared the risk of stone recurrence between patients managed with pharmacotherapy versus conservative therapy while controlling for disease severity.

“Pharmacotherapy for stone prevention in stone formers has proven effective, but compliance remains poor, primarily due to side effects. Our study aimed to determine if better patient risk stratification may help delineate what patients are most likely to benefit from pharmacotherapy,” said Dr. Johnson, assistant professor of urology, UT Southwestern Medical Center, Dallas.

“Our analyses showed a benefit of pharmacotherapy for delaying stone-related events in patients with a strong history of stones, but indicate that conservative therapy is likely to be as effective in lower risk patients.”

Also see: Stone management often falls short

The study pooled data from four academic centers that are participants in the Multicenter collaboration to Study Treatment Outcomes in Nephrolithiasis Evaluation (MSTONE). The centers include UT Southwestern, the University of Wisconsin, Madison, Vanderbilt University, Nashville, TN, and the University of Iowa, Iowa City.

It included 245 patients seen in the clinic for a stone event between July 2001 and April 2015, were managed with pharmacotherapy or conservative therapy comprised of fluid intake and dietary recommendations, and had a minimum follow-up of 1 year. Patients who started on conservative therapy and were switched to medical therapy were included in the pharmacotherapy group.

The patients were stratified into three risk groups according to the number of previous spontaneously passed stones: low risk, 0; moderate risk, ≤10; high risk, >10. The population included 62 low-risk patients, 147 in the intermediate-risk group, and 36 high-risk patients. The percentage of patients being treated with pharmacotherapy within the three risk groups was 48%, 64%, and 78%, respectively.

“Because this was not a randomized controlled trial, we recognized that patients who are at higher risk for a subsequent stone event would be managed more aggressively. To adjust for that difference, we stratified patients into risk groups taking into account their previous stone issues,” Dr. Johnson explained.

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