Leblanc Kori, Edwards Scott J, Dranitsaris George, Leong Darryl P, Carrier Marc, Malone Shawn, Rendon Ricardo A, Bond Alison M, Sitland Troy D, Zalewski Pawel, Wang Michelle, Emmenegger Urban
Department of Pharmacy, University Health Network, Toronto, ON M5G 2C4, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada.
Cancers (Basel). 2024 Sep 29;16(19):3336. doi: 10.3390/cancers16193336.
: Abiraterone acetate, apalutamide, darolutamide, and enzalutamide, which make up the androgen receptor axis-targeted therapies (ARATs) drug class, are commonly used in the management of prostate cancer. Many patients on ARATs also receive oral antithrombotic therapy (i.e., anticoagulants or antiplatelets). The concomitant use of ARATs and antithrombotic therapies creates the potential for clinically relevant drug-drug interactions, but the literature regarding the actual consequences of these interactions, and guidance for co-prescribing, is limited. We assembled a multidisciplinary panel of experts and provided them with clinical information derived from a comprehensive literature review regarding the drug-drug interactions between ARATs and antithrombotic therapies. : A three-stage modified electronic Delphi process was used to gather and consolidate opinions from the panel. Each stage consisted of up to three rounds of voting to achieve consensus on which ARAT/antithrombotic therapy drug pairs warrant attention, the possible clinical consequences of drug-drug interactions, and suggested actions for management. : The panel achieved consensus to avoid 11 ARAT/antithrombotic therapy drug pairs and modify therapy for eight pairs. Assessments relied heavily on pharmacokinetic data and extrapolation from drug-drug interaction studies of similarly metabolized drugs. : This e-Delphi process highlights the need for further research into the clinical impact of ARAT/antithrombotic drug interactions. Nonetheless, the suggested actions aim to provide clinicians with a practical framework for therapeutic decision making.
醋酸阿比特龙、阿帕他胺、达罗他胺和恩杂鲁胺构成了雄激素受体轴靶向治疗（ARATs）药物类别，常用于前列腺癌的治疗。许多接受ARATs治疗的患者也接受口服抗血栓治疗（即抗凝剂或抗血小板药物）。ARATs与抗血栓治疗同时使用会产生具有临床相关性的药物相互作用的可能性，但关于这些相互作用的实际后果以及联合用药指导的文献有限。我们组建了一个多学科专家小组，并为他们提供了从关于ARATs与抗血栓治疗之间药物相互作用的全面文献综述中得出的临床信息。
采用三阶段改良电子德尔菲法收集并整合专家小组的意见。每个阶段最多包括三轮投票，以就哪些ARAT/抗血栓治疗药物对需要关注、药物相互作用可能的临床后果以及建议的管理措施达成共识。
专家小组达成共识，避免使用11对ARAT/抗血栓治疗药物对，并对8对药物对的治疗进行调整。评估严重依赖药代动力学数据以及从类似代谢药物的药物相互作用研究中进行推断。
这种电子德尔菲法凸显了对ARAT/抗血栓药物相互作用的临床影响进行进一步研究的必要性。尽管如此，建议的措施旨在为临床医生提供一个实用的治疗决策框架。
