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Cardiovascular Effe...
Cardiovascular Effects of GnRH Antagonists Compared With Agonists in Prostate Cancer : A Systematic Review
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- Nelson, Adam J. (author)
- Duke Clinical Research Institute (DCRI)
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- Lopes, Renato D. (author)
- Duke Clinical Research Institute (DCRI)
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- Hong, Hwanhee (author)
- Duke Clinical Research Institute (DCRI),Duke University
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- Hua, Kaiyuan (author)
- Duke Clinical Research Institute (DCRI),Duke University
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- Slovin, Susan (author)
- Memorial Sloan-Kettering Cancer Center
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Tan, Sean (author)
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- Nilsson, Jan (author)
- Lund University,Lunds universitet,Kardiovaskulär forskning - immunitet och ateroskleros,Forskargrupper vid Lunds universitet,Cardiovascular Research - Immunity and Atherosclerosis,Lund University Research Groups
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- Bhatt, Deepak L. (author)
- Icahn School of Medicine at Mount Sinai
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- Goodman, Shaun G. (author)
- Saint Michael's Hospital
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- Evans, Christopher P. (author)
- University of California, Davis
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Clarke, Noel W. (author)
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Shore, Neal D. (author)
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- Margel, David (author)
- Rabin Medical Center
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- Klotz, Laurence H. (author)
- University of Toronto
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- Tombal, Bertrand (author)
- Saint-Luc University Hospital
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- Leong, Darryl P. (author)
- Hamilton Health Sciences
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- Alexander, John H. (author)
- Duke Clinical Research Institute (DCRI)
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- Higano, Celestia S. (author)
- Fred Hutchinson Cancer Research Center,University of British Columbia
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(creator_code:org_t)
- 2023
- 2023
- English 12 s.
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In: JACC: CardioOncology. - 2666-0873. ; 5:5, s. 613-624
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Abstract
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- Background: 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. Objectives: This study sought to determine whether GnRH antagonists were associated with fewer major adverse cardiovascular events compared with GnRH agonists. Methods: 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. Results: 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. Conclusions: 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- androgen deprivation
- gonadotropin-releasing hormone antagonist
- major adverse cardiovascular event
- prostate cancer
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- By the author/editor
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Nelson, Adam J.
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Lopes, Renato D.
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Hong, Hwanhee
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Hua, Kaiyuan
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Slovin, Susan
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Tan, Sean
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Nilsson, Jan
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Bhatt, Deepak L.
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Goodman, Shaun G ...
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Evans, Christoph ...
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Clarke, Noel W.
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Shore, Neal D.
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Margel, David
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Klotz, Laurence ...
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Tombal, Bertrand
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Leong, Darryl P.
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Alexander, John ...
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Higano, Celestia ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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JACC: CardioOnco ...
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Lund University