■雄激素剥夺疗法是晚期前列腺癌患者治疗的基石。小型的荟萃分析,以肿瘤学为重点的试验表明,促性腺激素释放激素(GnRH)拮抗剂与GnRH激动剂相比,可能与较少的心血管不良结局相关.
■本研究旨在确定与GnRH激动剂相比,GnRH拮抗剂是否与较少的主要心血管不良事件相关。
■搜索了所有预期的电子数据库,比较GnRH拮抗剂和激动剂的随机试验。主要结局是由以下标准化监管活动医学词典定义的主要不良心血管事件:“心肌梗塞,中枢神经系统出血和脑血管疾病,“和全因死亡率。拟合具有随机效应的贝叶斯元分析模型。
■总共纳入了11项符合条件的研究,最长持续时间为3至36个月(中位数=12个月),共有4,248名参与者。只有1次试验使用了盲法,裁定事件过程,鉴于开放标签设计,所有试验均存在潜在偏倚.共观察了152例主要结局事件,在GnRH拮抗剂治疗的参与者中,有2,655人(2.9%)中的76人,在激动剂治疗的个体中,有1,593人(4.8%)中的76人。与GnRH激动剂相比,GnRH拮抗剂对主要终点的合并OR分别为0.57(95%可信区间:0.37~0.86)和0.58(95%可信区间:0.32~1.08).
■尽管增加了最大的,专门的心血管结局试验,最终回答这个问题的可用数据的数量和质量仍然不理想。尽管有这些限制,现有数据表明GnRH拮抗剂与较少的心血管事件相关,可能还有死亡率,与GnRH激动剂相比。
UNASSIGNED: Androgen deprivation therapy is the cornerstone of treatment for patients with advanced prostate cancer. Meta-analysis of small, oncology-focused trials suggest gonadotropin-releasing hormone (GnRH) antagonists may be associated with fewer adverse cardiovascular outcomes compared with GnRH agonists.
UNASSIGNED: This study sought to determine whether GnRH antagonists were associated with fewer major adverse cardiovascular events compared with GnRH agonists.
UNASSIGNED: Electronic databases were searched for all prospective, randomized trials comparing GnRH antagonists with agonists. The primary outcome was a major adverse cardiovascular event as defined by the following standardized Medical Dictionary for Regulatory Activities terms: \"myocardial infarction,\" \"central nervous system hemorrhages and cerebrovascular conditions,\" and all-cause mortality. Bayesian meta-analysis models with random effects were fitted.
UNASSIGNED: A total of 11 eligible studies of a maximum duration of 3 to 36 months (median = 12 months) enrolling 4,248 participants were included. Only 1 trial used a blinded, adjudicated event process, whereas potential bias persisted in all trials given their open-label design. A total of 152 patients with primary outcome events were observed, 76 of 2,655 (2.9%) in GnRH antagonist-treated participants and 76 of 1,593 (4.8%) in agonist-treated individuals. Compared with GnRH agonists, the pooled OR of GnRH antagonists for the primary endpoint was 0.57 (95% credible interval: 0.37-0.86) and 0.58 (95% credible interval: 0.32-1.08) for all-cause death.
UNASSIGNED: Despite the addition of the largest, dedicated cardiovascular outcome trial, the volume and quality of available data to definitively answer this question remain suboptimal. Notwithstanding these limitations, the available data suggest that GnRH antagonists are associated with fewer cardiovascular events, and possibly mortality, compared with GnRH agonists.