Hupe Marie C, Hammerer Peter, Ketz Miriam, Kossack Nils, Colling Christiane, Merseburger Axel S
Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany.
Department of Urology, Academic Hospital Braunschweig, Brunswick, Germany.
Front Oncol. 2018 Nov 27;8:543. doi: 10.3389/fonc.2018.00543. eCollection 2018.
The objective of this study was to obtain real-world information on gonadotropin-releasing hormone agonist/antagonist (GnRHa) therapy in patients with advanced prostate cancer (PCa). Anonymized, routine healthcare claims data from approx. 75 German statutory health insurance funds from 2010-2015 ( = 4,205,227) were analyzed. Patients had an enrolment of 1 year before GnRHa, 1 index quarter of initial GnRHa prescription and ≥2 years of follow-up. In total, 2,382 patients with PCa were eligible. The most frequent index therapy was leuprolide in 56.6%. The rank order of PCa comorbidity prevalence was consistent over time (% at index and 3-years of follow-up): hypertension (71.5; 85.0), hyperlipidemia (45.2; 60.8), cardiovascular disease CVD) (35.7; 54.1), and diabetes (28.3; 36.2). Comparing pooled therapy classes (agonists, hybrids, and antagonist), no significant differences in the incidence of CVD or diabetes were observed. For hypertension, there was a significant increase for agonists (16.4%) compared to antagonists (6.9%, = 0.022) and leuprolide hybrid group (11.6%, = 0.006). During the follow-up period 23.9% of all PCa patients died. There were no significant differences concerning mortality rate and discontinuation rates between the cohorts. In total, 11.2% of all patients discontinued GnRHa after first prescription; the mean time to first switch to another GnRHa therapy was 100 days earlier for hybrids than for agonists ( = 0.016). This comparative retrospective analysis provides real-world information about healthcare characteristics and treatment patterns, highlighting the impact of different GnRHa on clinical outcomes for patients with advanced PCa in Germany.
本研究的目的是获取晚期前列腺癌（PCa）患者使用促性腺激素释放激素激动剂/拮抗剂（GnRHa）治疗的真实世界信息。分析了来自约75家德国法定健康保险基金在2010 - 2015年期间的匿名常规医疗保健理赔数据（n = 4,205,227）。患者在GnRHa治疗前有1年的参保期、1个初始GnRHa处方索引季度以及≥2年的随访期。总共2382例PCa患者符合条件。最常见的索引治疗药物是亮丙瑞林，占56.6%。PCa合并症患病率的排名顺序随时间保持一致（索引期和随访3年时的百分比）：高血压（71.5；85.0）、高脂血症（45.2；60.8）、心血管疾病（CVD）（35.7；54.1）和糖尿病（28.3；36.2）。比较汇总的治疗类别（激动剂、混合制剂和拮抗剂），未观察到CVD或糖尿病发病率的显著差异。对于高血压，激动剂组（16.4%）与拮抗剂组（6.9%，P = 0.022）和亮丙瑞林混合制剂组（11.6%，P = 0.006）相比有显著增加。在随访期间，所有PCa患者中有23.9%死亡。各队列之间的死亡率和停药率无显著差异。总共11.2%的患者在首次处方后停用GnRHa；混合制剂组首次改用另一种GnRHa治疗的平均时间比激动剂组早100天（P = 0.016）。这项比较性回顾性分析提供了有关医疗保健特征和治疗模式的真实世界信息，突出了不同GnRHa对德国晚期PCa患者临床结局的影响。
