A systematic review and meta-analysis of cardiovascular disease risk with degarelix and GnRH agonists in prostate cancer.

Background: Degarelix is a third-generation GnRH receptor antagonist approved for the treatment of prostate cancer, however, the decision to use a GnRH agonist or an antagonist depends on several factors. We aimed to perform a meta-analysis comparing the cardiovascular disease risk between degarelix and gonadotropin-releasing hormone agonists in patients with all stages of prostate cancer.

Methods: Databases were searched for randomized control trials (RCTs) and observational studies that compared the risk of cardiovascular disease between degarelix and GnRH agonists in patients with prostate cancer. We computed for binary endpoints risk ratio (RR) or hazard ratio (HR) with 95% confidence intervals (CI) which were analyzed using a random-effects model.

Results: A total of 15 studies were included with 123,969 patients and follow-up ranging from 3 to 13 months. Degarelix was associated with a significantly lower incidence of major adverse cardiovascular events (RR 0.59; 95% CI 0.41-0.84; p = 0.003; I = 84%). Incidence of stroke (RR 0.89; 95% CI 0.56-1.42; p = 0.62; I = 0%), all-cause mortality (RR 0.64; 95% CI 0.37-1.13; p = 0.12; I = 41%), hypertension (RR 0.71; 95% CI 0.48, 1.04; p = 0.08; I = 0%), myocardial infarction (HR 1.04; 95% CI 0·59-1·84; p = 0·86; I = 66%), heart failure (HR 0.79; 95% CI 0.38-1.62; p = 0.52; I2 = 79%) and arrhythmia (RR 0.63; 95% CI 0.28-1.41; p = 0.86; I = 37%), did not reach a statistically significant difference between groups.

Conclusion: In patients with prostate cancer, degarelix is associated with a significantly lower incidence of major adverse cardiovascular events.