A meta-analysis and systematic review of randomized controlled trials with degarelix versus gonadotropin-releasing hormone agonists for advanced prostate cancer

Sciarra, Alessandro; Fasulo, Andrea; Ciardi, Antonio; Petrangeli, Elisa; Gentilucci, Alessandro; Maggi, Martina; Innocenzi, Michele; Pierella, Federico; Gentile, V.; Salciccia, Stefano; Cattarino, Susanna

doi:10.1097/md.0000000000003845

Cited by 55 publications

(52 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One systematic review found no significant differences in risk for CV mortality between ADT and controls across all included studies (21). In other reviews, degarelix reduced the risk of CV events compared to GnRHa, as did IADT (12,15,25). There was a strong association between grade 3 cardiac adverse events and grade 3/4 vascular events and arbiraterone acetate + prednisone compared to placebo (23).…”

Section: Cardiac Disorders: Cardiovascular (Cv) Complications and Mormentioning

confidence: 99%

“…Five systematic reviews referred to incidence of vasomotor flushing across various treatments and stages of PC from locally advanced to metastatic CRPC (14,15,25,29,57). Anti-androgens have a significantly lower risk of flashing than orchiectomy (RR 0.23; 95% CI 0.10, 0.27) (14) and GnRH agonists (<1% vs 45%) (57).…”

Section: C Hot Flashesmentioning

confidence: 99%

“…Sexual dysfunction, which here refers to erectile dysfunction and decreased libido, is a common and often distressing experience for both men receiving ADT for PC and their partners. Two systematic reviews included RCTs with incidence of sexual dysfunction or decreased libido, one comparing erectile dysfunction between degarelix and GnRH agonists (RR 0.94 95% CI 0.700, 1.26, p=0.686) (25), the other IADT and continuous CADT for erectile dysfunction (RR 1.03; 95% CI 0.74, 1.43) and decreased libido (RR 1.01; 95% CI 0.95, 1.07) (15). No significant differences were found for erectile dysfunction or decreased libido between types of ADT.…”

Section: B Sexual Dysfunctionmentioning

confidence: 99%

See 2 more Smart Citations

Incidence of the adverse effects of androgen deprivation therapy for prostate cancer: a systematic literature review

Edmunds

Tuffaha

Galvão

et al. 2020

Support Care Cancer

View full text Add to dashboard Cite

PurposeAndrogen deprivation therapy (ADT) has broad application in the treatment of prostate cancer (PC) and is associated with numerous, debilitating adverse effects. Increasing use of ADT for PC, longer timeframe for treatment (increased uptake of PSA testing and earlier diagnosis), as well as improved survival and an ageing population, means patients can live for a considerable period of time on or after ADT, experiencing these adverse effects. A number of systematic reviews of adverse effects of ADT for PC exist, however, no single systematic review has previously examined the evidence for all adverse effects, including newer forms of ADT. MethodsA systematic review of existing systematic reviews of ADT for PC was conducted (2010 -February 2019), as per Cochrane guidelines, to identify the highest level of risk/incidence evidence available, supplemented by evidence drawn from individual studies where no systematic review existed. ResultsIncidence data was generated for 19 adverse effect sub groups, classified according to the common terminology criteria for adverse events (CTCAE). ConclusionIncidence of adverse effects provides valuable information for future burden of disease studies. This information can better guide clinical management to reduce symptoms for patients and assist patients to make more informed decisions about their treatment, potentially improving disease outcomes. It also highlights the importance of supportive care for PC patients receiving ADT and their carers. For analysts conducting economic evaluations, the inclusion of adverse effects in PC decision analytic models can provide more comprehensive and accurate information for decision makers.

show abstract

Section: Cardiac Disorders: Cardiovascular (Cv) Complications and Mormentioning

confidence: 99%

Section: C Hot Flashesmentioning

confidence: 99%

Section: B Sexual Dysfunctionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of the adverse effects of androgen deprivation therapy for prostate cancer: a systematic literature review

Edmunds

Tuffaha

Galvão

et al. 2020

Support Care Cancer

View full text Add to dashboard Cite

show abstract

“…29 In comparison, a metaanalysis of RCTs of phase III studies of degarelix, a GnRH antagonist, versus GnRH agonists found fewer reported severe adverse effects (1.6% v 3.6%, respectively), with an odds ratio of 0.55 (95% CI, 0.26 to 1.14) that favored the GnRH antagonist group. 30 Results of a clinical trial primarily evaluating cardiovascular outcomes between degarelix and leuprolide in men with advanced prostate cancer and preexisting cardiovascular disease are expected in 2020. 31 Treatment with the new hormonal agents, abiraterone and enzalutamide, has been associated with a 36% increased risk of cardiovascular events.…”

Section: Current Literature and Controversies In Adt And Cardiovasculmentioning

confidence: 99%

Cardiovascular and Metabolic Effects of Androgen-Deprivation Therapy for Prostate Cancer

Gupta

Chuy

Yang

et al. 2018

JOP

View full text Add to dashboard Cite

Androgen-deprivation therapy (ADT) entails lowering serum testosterone levels to castrate levels and forms a cornerstone of the management of hormone-sensitive advanced prostate cancer; however, the benefit of ADT is partially offset by its detrimental metabolic and cardiovascular adverse effects. ADT decreases insulin sensitivity while promoting dyslipidemia and sarcopenic obesity, which leads to an increased risk of cardiovascular morbidity and potentially mortality. The risk seems to be highest in elderly patients who have had recent cardiovascular events before starting ADT. It is prudent to engage in an individualized risk-benefit discussion and develop a cohesive multidisciplinary management plan to medically optimize and closely observe these patients before and during treatment with ADT.Careful history taking and physical examination to diagnose, treat, and optimize active CV disease with guideline-directed therapy before starting androgen-deprivation therapyConsider metformin for diabetes, ACEIs for HTN, aspirin for vascular health, and statins for hyperlipidemia in eligible patientsSmoking cessation, lifestyle modification, exercise, and stress reduction must be emphasized in all patients Awareness to seek immediate medical attention for new or worsening CV symptoms Abbreviations: ACEI, angiotension-converting enzyme inhibitor; CV, cardiovascular; HTN, hypertension.

show abstract

“…In the article “A meta-analysis and systematic review of randomized controlled trials with degarelix versus gonadotropin-releasing hormone agonists for advanced prostate cancer”, [1] which appeared in Volume 95, Issue 27 of Medicine , the fourth line of Table 2, “PSA progression-free survival in metastatic cases” was given incorrectly. The entry should have read “PSA progression rates in metastatic cases”.…”

mentioning

confidence: 99%