Filipe Cirne1, Nazanin Aghel1, Jo-Anne Petropoulos2, Laurence Klotz3, Daniel J Lenihan4, Fred Saad5, Jehonathan Pinthus6, Darryl P Leong1,7,8. 1. Department of Medicine, McMaster University and Hamilton Health Sciences, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada. 2. Health Sciences Library, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada. 3. Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. 4. Cardio-Oncology Center of Excellence, Washington University in St. Louis, 660 South Euclid, St. Louis, MO, 63110, USA. 5. University of Montreal Hospital Center, 900 Rue St. Denis, Montreal, Quebec, H2X 0A9, Canada. 6. Department of Surgery, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada. 7. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. 8. The Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton St. East, Hamilton, ON, L8L 2X2, Canada.
Abstract
AIMS: The aim of this study was to determine whether gonadotropin-releasing hormone (GnRH) antagonists (an emerging class of drugs to suppress testosterone synthesis in the treatment of prostate cancer) cause less adverse cardiovascular events than the more commonly use GnRH agonists. METHODS AND RESULTS: We conducted a systematic review to identify all randomized, controlled trials in which a GnRH antagonist was compared with a GnRH agonist in men with prostate cancer. We identified 10 eligible studies including two different GnRH antagonists, degarelix (n = 1681) and relugolix (n = 734), which were compared with the GnRH agonists, leuprolide (n = 714) and goserelin (n = 600). The pooled risk ratios (95% confidence intervals) among GnRH antagonist recipients for adverse cardiovascular events, cardiovascular death, and all-cause mortality were 0.57 (0.39-0.81); 0.49 (0.25-0.96); and 0.48 (0.28-0.83), respectively. Important limitations of the included trials were their short duration of follow-up, unblinded study design and (in most of the studies) the identification of adverse cardiovascular events through safety reporting mechanisms rather than as a pre-specified outcome. There was no evidence of heterogeneity of findings among the studies. CONCLUSIONS: There is consistent but methodologically limited data to suggest that GnRH antagonists-a relatively new class of androgen deprivation therapy for prostate cancer-cause significantly less cardiovascular adverse effects than the more frequently used GnRH agonists. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The aim of this study was to determine whether gonadotropin-releasing hormone (GnRH) antagonists (an emerging class of drugs to suppress testosterone synthesis in the treatment of prostate cancer) cause less adverse cardiovascular events than the more commonly use GnRH agonists. METHODS AND RESULTS: We conducted a systematic review to identify all randomized, controlled trials in which a GnRH antagonist was compared with a GnRH agonist in men with prostate cancer. We identified 10 eligible studies including two different GnRH antagonists, degarelix (n = 1681) and relugolix (n = 734), which were compared with the GnRH agonists, leuprolide (n = 714) and goserelin (n = 600). The pooled risk ratios (95% confidence intervals) among GnRH antagonist recipients for adverse cardiovascular events, cardiovascular death, and all-cause mortality were 0.57 (0.39-0.81); 0.49 (0.25-0.96); and 0.48 (0.28-0.83), respectively. Important limitations of the included trials were their short duration of follow-up, unblinded study design and (in most of the studies) the identification of adverse cardiovascular events through safety reporting mechanisms rather than as a pre-specified outcome. There was no evidence of heterogeneity of findings among the studies. CONCLUSIONS: There is consistent but methodologically limited data to suggest that GnRH antagonists-a relatively new class of androgen deprivation therapy for prostate cancer-cause significantly less cardiovascular adverse effects than the more frequently used GnRH agonists. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Renato D Lopes; Celestia S Higano; Susan F Slovin; Adam J Nelson; Robert Bigelow; Per S Sørensen; Chiara Melloni; Shaun G Goodman; Christopher P Evans; Jan Nilsson; Deepak L Bhatt; Noel W Clarke; Tine K Olesen; Belinda T Doyle-Olsen; Henriette Kristensen; Lauren Arney; Matthew T Roe; John H Alexander Journal: Circulation Date: 2021-08-30 Impact factor: 39.918
Authors: Alessandro Sciarra; Gian Maria Busetto; Stefano Salciccia; Francesco Del Giudice; Martina Maggi; Felice Crocetto; Matteo Ferro; Ettore De Berardinis; Roberto Mario Scarpa; Francesco Porpiglia; Luca Carmignani; Rocco Damiano; Walter Artibani; Giuseppe Carrieri Journal: Front Endocrinol (Lausanne) Date: 2021-06-14 Impact factor: 5.555