Abstract：
OBJECTIVE: Androgen receptor inhibitors (ARIs) have become an effective treatment for advanced prostate cancer (PC). However, it is unknown which ARI is the most helpful and safe for men with advanced PC. Our aim is to help physicians make clinical decisions and provide medication guidelines for patients with advanced PC to avoid potential risks when using ARIs for treatment.
METHODS: We systematically searched the following databases: PubMed, Embase and Cochrane Library, with a literature publication deadline of February 2023. The primary efficacy outcomes were 18-month overall survival (OS), treatment-emergent adverse events (TEAEs), hypertension and fatigue. The network meta-analysis (NMA) was performed by Stata 15.1, and Revman 5.3 was used to assess the included studies\' risk of bias.
RESULTS: The analysis included 26 trials with 26 263 people. The surface under the cumulative ranking curve (SUCRA) concluded that enzalutamide (86.8%) showed the best effect in prolonging the OS of patients. Flutamide led to the highest risk of TEAEs (29.9%) and AEs leading to discontinuation (12.8%). Apalutamide (13.4%) led to the highest risk of grade ≥3 TEAEs. Enzalutamide had the highest risk of hypertension (0.2%), grade ≥3 hypertension (4.5%) and fatigue (5.2%).
CONCLUSIONS: This NMA indicates there is no one ARI to reach both the most effective and safe therapy aims for treating advanced PC and that there is a compromise between the efficacy and safety of ARIs in the treatment of advanced PC. Physicians should weigh the risks to safety against the anticipated benefits when prescribing these drugs to patients with PC.
METHODS: We systematically searched the following databases: PubMed, Embase and Cochrane Library, with a literature publication deadline of February 2023. The primary efficacy outcomes were 18-month overall survival (OS), treatment-emergent adverse events (TEAEs), hypertension and fatigue. The network meta-analysis (NMA) was performed by Stata 15.1, and Revman 5.3 was used to assess the included studies\' risk of bias.
RESULTS: The analysis included 26 trials with 26 263 people. The surface under the cumulative ranking curve (SUCRA) concluded that enzalutamide (86.8%) showed the best effect in prolonging the OS of patients. Flutamide led to the highest risk of TEAEs (29.9%) and AEs leading to discontinuation (12.8%). Apalutamide (13.4%) led to the highest risk of grade ≥3 TEAEs. Enzalutamide had the highest risk of hypertension (0.2%), grade ≥3 hypertension (4.5%) and fatigue (5.2%).
CONCLUSIONS: This NMA indicates there is no one ARI to reach both the most effective and safe therapy aims for treating advanced PC and that there is a compromise between the efficacy and safety of ARIs in the treatment of advanced PC. Physicians should weigh the risks to safety against the anticipated benefits when prescribing these drugs to patients with PC.
摘要：
目的：雄激素受体抑制剂（ARIs）已成为晚期前列腺癌（PC）的有效治疗方法。然而,这是未知的ARI是最有帮助和安全的男人与先进的PC。我们的目标是帮助医生做出临床决策，并为患有高级PC的患者提供用药指南，以避免使用ARIs进行治疗时的潜在风险。
方法：我们系统地搜索了以下数据库：PubMed，Embase和Cochrane图书馆，文献出版截止日期为2023年2月。主要疗效结果为18个月总生存期（OS），治疗引起的不良事件（TEAE），高血压和疲劳。网络荟萃分析（NMA）由Stata15.1进行，Revman5.3用于评估纳入研究的偏倚风险。
结果：分析包括26项试验，26263人。累积排序曲线下的表面（SUCRA）得出结论，恩杂鲁胺（86.8％）在延长患者的OS方面表现出最佳效果。氟他胺导致最高的TEAE风险（29.9%）和导致停药的AE风险（12.8%）。阿帕鲁胺（13.4%）导致≥3级TEAE的风险最高。恩扎鲁胺的高血压风险最高（0.2％），≥3级高血压(4.5%)和疲劳(5.2%)。
结论：该NMA表明没有一种ARI能够达到治疗晚期PC的最有效和最安全的治疗目标，并且ARIs在治疗晚期PC的疗效和安全性之间存在折衷。医生在为PC患者开具这些药物时，应权衡安全性风险与预期益处。
方法：我们系统地搜索了以下数据库：PubMed，Embase和Cochrane图书馆，文献出版截止日期为2023年2月。主要疗效结果为18个月总生存期（OS），治疗引起的不良事件（TEAE），高血压和疲劳。网络荟萃分析（NMA）由Stata15.1进行，Revman5.3用于评估纳入研究的偏倚风险。
结果：分析包括26项试验，26263人。累积排序曲线下的表面（SUCRA）得出结论，恩杂鲁胺（86.8％）在延长患者的OS方面表现出最佳效果。氟他胺导致最高的TEAE风险（29.9%）和导致停药的AE风险（12.8%）。阿帕鲁胺（13.4%）导致≥3级TEAE的风险最高。恩扎鲁胺的高血压风险最高（0.2％），≥3级高血压(4.5%)和疲劳(5.2%)。
结论：该NMA表明没有一种ARI能够达到治疗晚期PC的最有效和最安全的治疗目标，并且ARIs在治疗晚期PC的疗效和安全性之间存在折衷。医生在为PC患者开具这些药物时，应权衡安全性风险与预期益处。
