Good analysis of database to estimate the neurotoxicity of hormonal treatments for PC. Takeaways 1) Yes they do cause cognitive impairment. And 2) Abiraterone +p is the only exception, reducing cognitive impairment in this analysis.
Neurocognitive impairment associated with traditional and novel androgen receptor signaling inhibitors ± androgen deprivation therapy: a pharmacovigilance study
nature.com/articles/s41391-...
Background
Conflicting evidence exists regarding whether hormone therapy for prostate cancer is associated with neurotoxicity. Thus, we aim to characterize the association between different types of hormone therapy and neurocognitive impairment in a real-world pharmacovigilance database.
Methods
We queried VigiBase, the World Health Organization’s international pharmacovigilance database, for reports of neurocognitive impairment among men who took hormone therapy from 1968 to 2021. We performed disproportionality analysis comparing rates of neurocognitive impairment with different types of hormone therapy versus other VigiBase drugs. Traditional hormonal therapy was defined as androgen deprivation therapy (ADT: gonadotropin-releasing-hormone agonists or antagonists) or first-generation androgen receptor (AR) antagonists. Novel AR signaling inhibitors (ARSIs) were defined as ARSIs with or without ADT. Differences were assessed using reporting odds ratio (ROR) with 95% confidence intervals (CI) and Empirical Bayes Estimator (EBE) values ≥1.0 signifying statistical significance.
Results
Odds of neurocognitive impairment were significantly elevated with traditional hormone therapy (ROR 1.47, 95% CI 1.34–1.62, EBE = 1.35) and novel ARSIs (ROR 2.40, 95% CI 2.28–2.54, EBE = 2.26). Odds of neurocognitive impairment were significantly elevated with enzalutamide (ROR 2.89, 95% CI 2.73–3.05, EBE = 2.70) and numerically increased with apalutamide (ROR 3.31, 95% CI 1.57–7.00, EBE = 0.98), but were decreased with abiraterone (ROR 0.68, 95% CI 0.55–0.84, EBE = 0.57).
Conclusions
This study demonstrates elevated odds of neurocognitive impairment with hormone therapy in a real-world data set. Neurotoxicity risk was higher with novel ARSIs than traditional agents, and higher with enzalutamide than abiraterone. Due to limitations inherent to disproportionality analysis (measuring associations, not risk) and incomplete data prohibiting the ability to control for factors such as age or use of secondary drugs (e.g., concurrent use of novel ARSIs with ADT), results are exploratory in nature. The amalgamation of these and other conflicting data may contribute to clinical decision-making for men with prostate cancer eligible for treatment with these therapies, especially those with significant neurologic comorbidities.
Most anyone who has been on ADT can vouch for the dreaded brain fog. I used to test myself by trying to recall a 4 digit code for 10 seconds. At the worst point I could only remember 2 of the digits. Now I can easily recall 8 digits.
Fascinating that abi might help your brain. I wonder why? Is this a new super brain drug that will soon be the rage at college campuses? I wonder if it has anything to do with my 8-digit recall and the fact that I have a better memory than my 17 year younger wife? (I take abi to underlie BAT)
Now I know what the drug was in the movie Limitless.
I bet it’s the prednisone
Limitless- My favorite movie... 1st 1/3 anyway, then it got dark.
Agreed. However, I was expecting the typical dark ending. Drugs and trying to exceed your limits. Usually, that calls for some kind of thinly veiled warning. I was surprised by the Limitless ending.
The message seemed to be: stay in your cozy little mediocre box but if you go outside it, give it your all if you want to get it all.
Haha Scout, got dark because he got greedy. Great movie!
I would take that drug in a heart beat.
I would run marathons again and my husband would start competing world bench press, we would be a super couple..lol dream on!!!
Got dark because he only got 75% greedy. At the end he went 100%. Synapses rewired permanently and he won big. Loved the fact that it didn't end with a lame drug warning.
8 digits? That's nuttin..... I can recall my land line telephone number (including the country code 1 and the separating dashes or periods)....
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 05/03/2022 7:22 PM DST
I got you beat I know my grandmoms. HI 9-8115. Lol she’s been gone forever!
Very strange..... I found that telephone number in my grandfathers wallet, she must have been beautiful cause he only liked lovely women..................(???)
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 05/03/2022 8:25 PM DST
Lol!!!
Class !!!......pay attention
With everything that all of us are going through, or have been through, it’s just so wonderful to smile and laugh… loving this group !
Long term memory is interesting. I remember the phone number to the house I lived in when I was 6.
But what I meant was that I can look at an 8 digit code for a couple of seconds and then it is committed to memory (part of a secure login system - when I was on ADT I would have to try to memorize 2 digits, switch sites, enter those, go back....).
I have a hobby of researching immigrants (usually notable people or relatives of friends of mine) and document the notable ones in an email to the Ellis Island Foundation. Part of the documentation is including "the passenger number" which I have to enter part of the number several times to get the full number.
Now for a trivia question.... In the old days telephone numbers included a sort of an area alphabetic prefix in the telephone numbers: e.g. CY2-0966 stood for CYpress2-0966. There was a Group* of people who were opposed to replacing the alpha CY to digits 292-0966. (And of course Pennsylvania 6-5000 Song by Glenn Miller)
Now here it is, what was the name of the *Group?
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 05/03/2022 10:51 PM DST
The stickinthemudlets?
Close but no cigar........... (however a perfect name for my ex-wife's family)...See cancerfox's perfect answer....
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 05/03/2022 11:18 PM DST
Oh my gosh, I’m laughing again!
The Anti-Digit Dialing League was against the elimination of prefix names.
B I N G O!!!
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 05/03/2022 11:16 PM DST
What did they have against fingers and toes? How would we count without them?
After reading all of your comments, I asked my husband if he was feeling some brain fog or forgetfulness…His reply was sometimes. I am feeling like he doesn’t want to tell me everything😥
Glad to hear you are laughing again. I was going to suggest that for you both. The challenges of dealing with cancer requires humor. Sometimes irreverent but never disrespectful. And remember that some of us enjoy digging into the deep end of biology and physiology. What is important is not complicated I’m the end. Paul
I agree Paul, respecting both❤️
Sometimes my wife would trade places with you. I divulge EVERYTHING!