Evidence‐based medicine: comparative analysis of luteinizing hormone‐releasing hormone analogues in combination with external beam radiation and surgery in the treatment of carcinoma of the prostate

Abstract

What’s known on the subject? and What does the study add? Luteinizing hormone‐releasing hormone analogues are a cornerstone in the management of many clinical situations in prostate cancer patients. The multiplicity of drugs make it difficult to decide which is the best drug to prescribe to each patient. Whether or not the different luteinizing hormone‐releasing hormone analogues belong to the same drug class is only merely supposed. This study adds a systematic review of the literature in order to determine whether or not the luteinizing hormone‐releasing hormone analogues available for prescription belong to the same drug class (same family, similar chemical structure, mechanism of action, and efficacy). The current evidence available is not enough to support a presumed drug class effect of the various analogues in the treatment of prostate carcinoma. OBJECTIVE • To study whether luteinizing hormone‐releasing hormone (LHRH) analogues are agents of the same pharmacological class, i.e. whether they have the same clinical effect, using an evidence‐based medicine approach. MATERIAL AND METHODS • We reviewed the evidence on the alleged ‘drug class effect’ among analogues and the existing bibliographic support for their use in various medical indications. We used PubMed as the main search source. Evidence level and degree of recommendation were assigned to each conclusion based on the ‘Scottish Intercollegiate Guidelines Network’. RESULTS • There are no studies designed to answer the question of class effect between LHRH analogues or agonists. Reviews and meta‐analyses have been performed on many other issues related to therapeutic management either with analogues alone, or in combination with radiation therapy and surgery. • Direct comparisons do not allow definitive conclusions to be reached. Indirect evidence is obtained from randomized studies comparing the different LHRH analogues with other treatments used to obtain androgen deprivation. Other issues related to pharmacokinetics and pharmacodynamics that can support either the existence or non‐existence of class effect were evaluated. CONCLUSION • The current available evidence is not enough to support a presumed class effect of the drug among the different analogues in the treatment of prostate carcinoma in its various clinical situations.

Androgenic suppression combined with radiotherapy for the treatment of prostate adenocarcinoma: a systematic review

“…Chemical androgen deprivation is reported to be similar among the different types of analogues used, although there is fear that sudden elevations in the level of testosterone, according to distinct pharmacodynamic characteristics, could interfere with treatment and ultimately compromise survival [25]. Authors of a recent systematic review did not provide evidence of such a presumed effect from the analogues used in practice [26]. …”