The GnRH antagonist degarelix was associated with a decreased risk of heart failure in prostate cancer patients with prior cardiovascular disease (HR 0.46), but an increased risk of arrhythmia in those without prior cardiovascular disease compared to GnRH agonists.
Cohort (n=10,785)
Does a GnRH antagonist reduce the risk of cardiovascular events compared to GnRH agonists in patients with prostate cancer?
In patients with prostate cancer, GnRH antagonists may be associated with a lower risk of heart failure in those with prior CVD and lower risk of ischemic heart disease in those without prior CVD compared to GnRH agonists, though arrhythmia risk may be increased.
Hazard Ratio: 1.32 (95% CI 1.13–1.54)
Absolute Event Rate: 15.03% vs 10.73%
p-value: p=0.0006
BACKGROUND: Controversy exists regarding the risk of cardiovascular disease (CVD) associated with androgen deprivation therapy (ADT) in patients with prostate cancer. We sought to evaluate the association between gonadotropin-releasing hormone (GnRH) agonists versus GnRH antagonist and the risk of CVD in patients with prostate cancer with or without prior CVD. PATIENTS AND METHODS: Using administrative databases from Quebec, Canada, we identified first-time GnRH agonists and antagonist (degarelix) users between January 2012 and June 2016. Follow-up ended at the earliest of the following: first CVD event (myocardial infarction MI, stroke, ischemic heart disease IHD, arrhythmia, and heart failure HF); switch of GnRH group; death; or December 31, 2016. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to control for potential confounding. IPTW-Cox proportional hazards model accounting for competing risks was used to evaluate the association of interest. RESULTS: Among 10,785 patients identified, 10,201 and 584 were on GnRH agonists and antagonist, respectively. Median age was 75 years (interquartile range, 69-81 years) for both groups. A total of 4,152 (40.7%) men in the GnRH agonists group and 281 (48.1%) men in the GnRH antagonist group had CVD in the 3-year period prior to ADT initiation. Risk of HF was decreased in the antagonist group compared with the GnRH agonist group among patients with prior CVD (hazard ratio HR, 0.46; 95% CI, 0.26-0.79). Risk of IHD was decreased in the antagonist group in patients without prior CVD (HR, 0.26; 95% CI, 0.11-0.65). Use of antagonist was associated with an increased risk of arrhythmia among patients with no prior CVD (HR, 2.34; 95% CI, 1.63-3.36). CONCLUSIONS: Compared with GnRH agonists, the GnRH antagonist was found to be associated with a decreased risk of HF, specifically among patients with prior CVD. Among those with no prior CVD, the GnRH antagonist was associated with a decreased risk of IHD but an increased risk of arrhythmia.
Dragomir et al. (Wed,) conducted a cohort in Prostate cancer (n=10,785). GnRH antagonist (degarelix) vs. GnRH agonists was evaluated on Aggregate cardiovascular disease (myocardial infarction, stroke, heart failure, arrhythmia, and ischemic heart disease) (HR 1.32, 95% CI 1.13-1.54, p=0.0006). The GnRH antagonist degarelix was associated with a decreased risk of heart failure in prostate cancer patients with prior cardiovascular disease (HR 0.46), but an increased risk of arrhythmia in those without prior cardiovascular disease compared to GnRH agonists.
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