促性腺激素释放激素拮抗剂与促性腺激素释放激素激动剂治疗前列腺癌的心血管不良效应：系统评价和荟萃分析。
Adverse cardiovascular effect following gonadotropin-releasing hormone antagonist versus GnRH agonist for prostate cancer treatment: A systematic review and meta-analysis.
机构信息
Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
出版信息
Front Endocrinol (Lausanne). 2023 Mar 31;14:1157857. doi: 10.3389/fendo.2023.1157857. eCollection 2023.
BACKGROUND
Androgen deprivation therapy is the mainstay of medical treatment for prostate cancer (Pca); however, it is associated with an increased risk of adverse cardiovascular (CV) events and death. To date, CV death has been the leading noncancer cause of death in Pca patients. Both GnRH antagonists (an emerging class of drugs) and GnRH agonists (most frequently prescribed) are efficacious against Pca. However, the adverse effects, especially the adverse CV effect between them remain unclear.
METHODS
Through a literature search using MEDLINE, EMBASE and the Cochrane Library, all available studies comparing the safety of CV risk between GnRH antagonists and GnRH agonists in Pca patients were extracted. Comparisons of outcomes of interest between these two classes of drugs were calculated using the risk ratio (RR). Subgroup analyses were performed depending on the study design and preexisting CV disease at baseline.
RESULTS
Nine randomized controlled clinical trials (RCTs) and five real-world observational studies comprising 62160 Pca patients were included in our meta-analysis. Patients receiving GnRH antagonists experienced fewer CV events (RR: 0.66, 95% CI:0.53-0.82, P<0.001), CV death (RR:0.4, 95% CI: 0.24-0.67, P<0.001) and myocardial infarctions (RR: 0.71, 95% CI: 0.52-0.96, P=0.03). No difference was found in the incidence of stroke and heart failure. Moreover, GnRH antagonists were associated with fewer CV events in patients with preexisting CV disease but not in those without preexisting CV disease in the RCT series.
CONCLUSION
GnRH antagonists appear to offer favorable safety in terms of adverse CV events and CV death compared with GnRH agonists among men diagnosed with Pca, especially those who had established CV disease at baseline.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2023-2-0009/, identifier INPLASY202320009.
背景
去势治疗是前列腺癌（Pca）的主要治疗方法；然而，它与心血管不良事件（CV）风险增加和死亡相关。迄今为止，CV 死亡一直是 Pca 患者的主要非癌症死因。促性腺激素释放激素拮抗剂（一种新兴的药物类别）和促性腺激素释放激素激动剂（最常开的药物）对 Pca 都有效。然而，它们之间的不良反应，尤其是心血管不良影响仍不清楚。
方法
通过使用 MEDLINE、EMBASE 和 Cochrane 图书馆进行文献检索，提取了所有比较 GnRH 拮抗剂和 GnRH 激动剂在 Pca 患者中 CV 风险安全性的可用研究。使用风险比（RR）计算这两类药物之间感兴趣结局的比较。根据研究设计和基线时是否存在预先存在的 CV 疾病进行亚组分析。
结果
纳入了我们的荟萃分析的共有 9 项随机对照临床试验（RCT）和 5 项真实世界观察性研究，包含 62160 名 Pca 患者。接受 GnRH 拮抗剂治疗的患者发生 CV 事件（RR：0.66，95%CI：0.53-0.82，P<0.001）、CV 死亡（RR：0.4，95%CI：0.24-0.67，P<0.001）和心肌梗死（RR：0.71，95%CI：0.52-0.96，P=0.03）的风险较低。在卒中和心力衰竭的发生率方面没有差异。此外，在 RCT 系列中，在基线时患有预先存在的 CV 疾病的患者中， GnRH 拮抗剂与较少的 CV 事件相关，但在没有预先存在的 CV 疾病的患者中则没有差异。
结论
与 GnRH 激动剂相比，在被诊断患有 Pca 的男性中，GnRH 拮抗剂在 CV 事件和 CV 死亡方面似乎具有更好的安全性，尤其是那些在基线时已经患有 CV 疾病的患者。
声明：本译文仅供参考，译文内容可能存在与原文差异，一切以原文为准。
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