New study below [1].
Men with PCa have a greater risk of death from cardiovascular [CV] events, and androgen deprivation therapy [ADT] further increases that risk.
The study looked at ADT drugs that target gonadotropin-releasing hormone (GnRH) receptors in the pituitary gland.
The drugs were Degarelix [Firmagon], Buserelin [Suprefact], Goserelin [Zoladex], Leuprorelin [Lupron] and Triptorelin [Decapeptyl].
The data used was Eudra-Vigilance (EV) and Food and Drug Administration (FDA) reported AEs (adverse events).
Buserelin, Goserelin, Leuprorelin & Triptorelin are GnRH agonists, whereas Degarelix is a GnRH antagonist.
{"Unlike GnRH agonists, which cause an initial stimulation of the hypothalamic-pituitary-gonadal axis (HPGA), leading to a surge in testosterone levels, and under certain circumstances, a flare-up of the tumour, GnRH antagonists do not cause a surge in testosterone or clinical flare.[11] Clinical flare is a phenomenon that occurs in patients with advanced disease, which can precipitate a range of clinical symptoms such as bone pain, urethral obstruction, and spinal cord compression. Drug agencies have issued boxed warnings regarding this phenomenon in the prescribing information for GnRH agonists. As testosterone surge does not occur with GnRH antagonists, there is no need for patients to receive an antiandrogen as flare protection during prostate cancer treatment. GnRH agonists also induce an increase in testosterone levels after each reinjection of the drug – a phenomenon that does not occur with GnRH antagonists such as degarelix." [2]}
Degarelix presented with lower risk of
- hypertension
- myocardial infarction
- thrombosis
when compared to GnRH agonists.
Overall, cardiovascular events were reported in
6% of Degarelix users
9% of Buserelin users
7% of Goserelin users
5% of Leuprorelin users
5% of Triptorelin users
***
The above will be old news to some here.
From 2018 [3]:
"To our knowledge this is the first prospective study to test cardiovascular outcomes among patients with prostate cancer who received androgen deprivation therapy. No differences in the primary end point were noted between the study arms. However, the secondary end point revealed that patients treated with GnRH agonist experienced significantly more major cardiovascular and cerebrovascular events than those treated with GnRH antagonist."
However, a meta-analysis (2021) [4] reported that:
"risks of CVD in PCa patients was the same"
Note that the decision to use a GnRH antagonist is not a random event these days. There is bias. If men with CV comorbidities are mostly choosing Degarelix, and the CVD risks appear to be identical, that proves that Degarelix must be protective, compared to an agonist, for that population.
***
What's needed for clarification is an analysis of adverse events by CV comorbidity & perhaps age. This would help patients/doctors in the decision process.
-Patrick
[1] pubmed.ncbi.nlm.nih.gov/366...
[2] en.wikipedia.org/wiki/Degar...
