前列腺癌患者促性腺激素释放激素拮抗剂和激动剂的心血管安全性比较:真实世界证据研究的系统回顾和元分析》。

IF 8.3 1区 医学 Q1 ONCOLOGY European urology oncology Pub Date : 2024-09-28 DOI:10.1016/j.euo.2024.09.004
Savan Patel, Kexin Zhu, Chintan V Dave, Mina Ghajar, Yingting Zhang, Biren Saraiya, Elisa V Bandera, Farzin Khosrow-Khavar
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引用次数: 0

摘要

背景和目的:促性腺激素释放激素(GnRH)拮抗剂和激动剂是治疗前列腺癌的基础药物。然而,临床试验中有关这些药物的心血管安全性比较的证据尚无定论。本研究旨在系统评估真实世界证据研究中 GnRH 拮抗剂与 GnRH 促效剂发生不良心血管事件的风险:我们对 PubMed、Embase、Cochrane Library、Scopus 和 Web of Science(2008-2023 年)进行了系统检索。我们纳入了对前列腺癌患者使用 GnRH 拮抗剂和 GnRH 激动剂的心血管后果风险进行比较的真实世界证据研究。我们使用随机效应模型对存在低度或中度偏倚风险的研究的效果估计值进行了荟萃分析,该分析是通过非随机干预研究中的偏倚风险(ROBINS-I)工具进行评估的:在纳入的 10 项研究中,有 4 项研究存在中度偏倚风险,6 项研究存在严重偏倚风险。在主要分析中,三项研究存在中度偏倚风险,其中地加瑞克与主要不良心血管事件(MACEs)风险增加有关(汇总相对风险[RR]:1.31,95%置信区间[CI]:1.14-1.51)。两项研究观察到,有心血管疾病史的患者的风险增加(汇总相对风险:1.31,95% 置信区间:1.11-1.56),而一项研究观察到无心血管疾病史的患者的风险增加(相对风险:1.15,95% 置信区间:0.83-1.59):真实世界的证据研究表明,与GnRH激动剂相比,地加瑞克会适度增加MACE的风险,尤其是在有心血管疾病史的患者中。然而,用地加瑞克治疗高危患者可能会导致这些结果。患者总结:在这项对常规治疗中确诊为前列腺癌的患者进行的系统性证据评估中,与促性腺激素释放激素激动剂相比,地加瑞克与较高的心血管不良结局相关。
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Comparative Cardiovascular Safety of Gonadotropin-releasing Hormone Antagonists and Agonists Among Patients Diagnosed with Prostate Cancer: A Systematic Review and Meta-analysis of Real-world Evidence Studies.

Background and objective: Gonadotropin-releasing hormone (GnRH) antagonists and agonists are cornerstone treatments in prostate cancer. However, evidence regarding the comparative cardiovascular safety of these drugs from clinical trials is inconclusive. The objective of this study was to systematically assess the risk of adverse cardiovascular events of GnRH antagonists compared with GnRH agonists across real-world evidence studies.

Methods: We conducted a systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science (2008-2023). We included real-world evidence studies comparing the risk of cardiovascular outcomes of GnRH antagonists with those of GnRH agonists among patients with prostate cancer. We conducted a meta-analysis of effect estimates across studies at a low or moderate risk of bias, assessed via the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool, using random-effect models.

Key findings and limitations: Among ten included studies, four were classified as having a moderate and six as having a serious risk of bias. Across three studies at a moderate risk of bias in the primary analysis, degarelix was associated with an increased risk (pooled relative risk [RR]: 1.31, 95% confidence interval [CI]: 1.14-1.51) of major adverse cardiovascular events (MACEs). An augmented risk was observed in two studies among patients with a history of cardiovascular disease (pooled RR: 1.31, 95% CI: 1.11-1.56) compared with one study among patients without a history of cardiovascular disease (RR: 1.15, 95% CI: 0.83-1.59).

Conclusions and clinical implications: Real-world evidence studies indicate that degarelix, compared with GnRH agonists, is associated with a modest increased risk of MACEs, particularly among patients with a history of cardiovascular disease. However, residual confounding due to the treatment of high-risk patients with degarelix may account for these findings. Additional large studies with detailed data on tumor characteristics and cardiovascular risk factors are needed to confirm these findings.

Patient summary: In this systematic evaluation of evidence among patients diagnosed with prostate cancer in routine care, degarelix was associated with higher cardiovascular adverse outcomes than gonadotropin-releasing hormone agonists.

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来源期刊
CiteScore
15.50
自引率
2.40%
发文量
128
审稿时长
20 days
期刊介绍: Journal Name: European Urology Oncology Affiliation: Official Journal of the European Association of Urology Focus: First official publication of the EAU fully devoted to the study of genitourinary malignancies Aims to deliver high-quality research Content: Includes original articles, opinion piece editorials, and invited reviews Covers clinical, basic, and translational research Publication Frequency: Six times a year in electronic format
期刊最新文献
Value of Whole-body Magnetic Resonance Imaging Using the MET-RADS-P Criteria for Assessing the Response to Intensified Androgen Deprivation Therapy in Metastatic Hormone-naïve and Castration-resistant Prostate Cancer. Management of Small Testicular Masses: A Delphi Consensus Study. Reply to Alireza Ghoreifi and Hooman Djaladat's Letter to the Editor re: Yiling Chen, Chenyang Xu, Zezhong Mou, et al. Endoscopic Cryoablation Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2024.04.012. Oncological Outcomes of Active Surveillance versus Surgery or Ablation for Patients with Small Renal Masses: A Systematic Review and Quantitative Analysis. Re: Yiling Chen, Chenyang Xu, Zezhong Mou, et al. Endoscopic Cryoablation Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2024.04.012.
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