Kate Johnson

October 20, 2015

BALTIMORE — Almost 60% of clinicians prescribe so-called bioidentical compounded menopausal hormone therapy, against recommendations from major medical societies, according to a new survey.

And 47% of respondents said they disagree with society recommendations that patients should be told that conventional hormone therapy is more appropriate than compounded preparations not approved by the US Food and Drug Administration.

"There is some discrepancy, some disconnect, between the national organizations and clinicians," said Jamie Peregrine-Dubaut, MD, from the University of Kansas School of Medicine in Wichita, who presented the findings here at the American Society for Reproductive Medicine 2015 Annual Meeting

According to a recent survey conducted by the North American Menopause Society (NAMS), 41% of patients are choosing compounded, non-FDA-approved preparations, despite society recommendations against them, as previously reported by Medscape Medical News.

But many physicians say they are comfortable with this practice, according to Dr Peregrine-Dubaut.

The researchers emailed 1349 clinicians in Kansas, and 150 completed the online survey, for an 11% response rate. Of the respondents, 55% were family practitioners and 45% were obstetrician, gynecologists.

 
There is some discrepancy, some disconnect, between the national organizations and clinicians.
 

A total of 59% of respondents reported having prescribed noncommercial compounded hormones, and 85% reported having prescribed conventional hormone therapy.

And 47% of respondents said they disagree or strongly disagree with the recommendation from the American College of Obstetricians and Gynecologists (ACOG), NAMS, the Endocrine Society, and the American College of Clinical Pharmacy that patients be counseled that conventional hormone therapy is more appropriate than compounded preparations.

Strongly Disagree

Of those who disagreed, 36% were obstetrician, gynecologists and 58% were family practitioners (P = .01).

"These same clinicians cited safety and efficacy as some of the most important factors in their prescribing choices," Dr Peregrine-Dubaut pointed out.

Efficacy was cited by 74% of respondents, risks by 64%, tolerability by 64%, cost by 55%, and patient preference by 55%.

When asked whether they agree that the variable purity, potency, efficacy, and safety of compounded hormones pose risks, 26% of respondents said they did not. And 16% of respondents said they disagree that physicians should exercise caution when prescribing compounded hormones when conventional alternatives exist.

 
These same clinicians cited safety and efficacy as some of the most important factors in their prescribing choices.
 

"This report underscores the importance of strong statements from medical societies that serve to inform and guide the clinical practice of their members along the path of best practices," said NAMS Executive Director Emeritus Margery Gass, MD.

David Archer, MD, past-president of NAMS, who was in the audience, said he is confused by the findings.

"How would you expect family practitioners to know ACOG opinion?" he asked Dr Peregrine-Dubaut.

"The survey asked if they agree with statements from the recommendations, not the recommendations themselves," she explained.

"Because of the way they asked the question, I'm sure that the answers are highly biased," Dr Archer told Medscape Medical News. "If I was a family practitioner and was asked if I agree with the ACOG committee opinion, how would I know what that would be?"

There could have been "some people who didn't comprehend the question," Dr Archer concluded.

Still, 36% of respondents who said they disagreed were obstetrician, gynecologists.

"We believe there is increasing deviation of clinical practice from national guidelines regarding compounded bioidentical menopausal hormone therapy," Dr Peregrine-Dubaut told Medscape Medical News. "And we think it is academically important to investigate why that might be so."

Dr Peregrine-Dubaut and Dr Gass have disclosed no relevant financial relationships. Study coauthor David Grainger, MD, from the University of Kansas School of Medicine, is on a speaker's bureau for AbbVie and Sinogi, Inc. Dr Archer is a consultant for Sermonix Pharmaceuticals LLC.

American Society for Reproductive Medicine (ASRM) 2015 Annual Meeting: Abstract O-8. October 19, 2015.

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