Axel S Merseburger1, Daniel Sedding2, Kai Hüter3. 1. Klinik und Poliklinik für Urologie, Akkreditiertes Zweitmeinungszentrum Keimzelltumoren, Zertifiziertes Kontinenz- und Beckenboden-Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 60, 23538, Lübeck, Deutschland. axel.merseburger@uksh.de. 2. Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland. 3. Urologie am Nordkopf, Wolfsburg, Deutschland.
Abstract
BACKGROUND: Androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists or GnRH antagonists is the mainstay of treatment for metastatic prostate cancer (mCaP). However, ADT is associated with serious cardiovascular events. Only a few studies that directly compare the cardiovascular risk of LHRH agonists versus GnRH antagonists have been published. OBJECTIVES: This review aims to compare the cardiovascular risk of LHRH agonists versus GnRH antagonists based on the literature. METHODS: A literature search that considered full publications and abstracts published before December 10, 2014 was performed. Due to their high evidence quality, only meta-analyses and pooled studies were included in this review. RESULTS: Four studies were included. These investigated the cardiovascular risk of patients receiving an ADT with LHRH agonists and/or GnRH antagonists. However, only one of these directly compared the cardiovascular risk of ADT with LHRH agonists versus GnRH antagonists. This meta-analysis showed a significant reduction in cardiovascular risk for patients receiving a GnRH antagonist compared to those patients receiving a LHRH agonist (HR: 0.597; 95 % CI: 0.380-0.938; P = 0.0253). Subgroup analyses showed that, in particular, patients with pre-existing cardiovascular diseases who were treated with a GnRH antagonist have a significantly lower risk of experiencing a cardiovascular event when compared with patients receiving a GnRH agonist (HR: 0.44; 95 % CI: 0.26-0.74; P = 0.002). CONCLUSION: In conclusion, GnRH antagonists are associated with a lower risk of cardiovascular events, compared with LHRH agonists, when administered as ADT in CaP patients, and particularly in patients with a history of cardiovascular disease. Thus, patients with a history of cardiovascular disease may benefit from ADT with a GnRH antagonist.
BACKGROUND: Androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists or GnRH antagonists is the mainstay of treatment for metastatic prostate cancer (mCaP). However, ADT is associated with serious cardiovascular events. Only a few studies that directly compare the cardiovascular risk of LHRH agonists versus GnRH antagonists have been published. OBJECTIVES: This review aims to compare the cardiovascular risk of LHRH agonists versus GnRH antagonists based on the literature. METHODS: A literature search that considered full publications and abstracts published before December 10, 2014 was performed. Due to their high evidence quality, only meta-analyses and pooled studies were included in this review. RESULTS: Four studies were included. These investigated the cardiovascular risk of patients receiving an ADT with LHRH agonists and/or GnRH antagonists. However, only one of these directly compared the cardiovascular risk of ADT with LHRH agonists versus GnRH antagonists. This meta-analysis showed a significant reduction in cardiovascular risk for patients receiving a GnRH antagonist compared to those patients receiving a LHRH agonist (HR: 0.597; 95 % CI: 0.380-0.938; P = 0.0253). Subgroup analyses showed that, in particular, patients with pre-existing cardiovascular diseases who were treated with a GnRH antagonist have a significantly lower risk of experiencing a cardiovascular event when compared with patients receiving a GnRH agonist (HR: 0.44; 95 % CI: 0.26-0.74; P = 0.002). CONCLUSION: In conclusion, GnRH antagonists are associated with a lower risk of cardiovascular events, compared with LHRH agonists, when administered as ADT in CaPpatients, and particularly in patients with a history of cardiovascular disease. Thus, patients with a history of cardiovascular disease may benefit from ADT with a GnRH antagonist.
Authors: Marianne Schmid; Jesse D Sammon; Gally Reznor; Victor Kapoor; Jacqueline M Speed; Firas A Abdollah; Akshay Sood; Felix K-H Chun; Adam S Kibel; Mani Menon; Margit Fisch; Maxine Sun; Quoc-Dien Trinh Journal: BJU Int Date: 2015-07-22 Impact factor: 5.588
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